機器人手臂協助部分腎臟切除後影響腎動脈假性血管瘤發生的臨床因子：
單一醫學中心腎功能分析
黃裕賓1、鍾孝仁1,2、黃奕燊1,2、林子平1,2、黃逸修1,2、盧星華2,3、邱文祥4、黃志賢1,2
台北榮民總醫院 泌尿部1；國立陽明交通大學醫學院 泌尿學科 書田泌尿科學研究中心2；
台北榮民總醫院桃園分院3；台北市立聯合醫院4
Clinical Factors that Influence the Occurrence of Renal Artery Pseudoaneurysms after Robotic Assisted Partial Nephrectomy: Single Center Study of Renal Function Outcomes
Yu-Pin Huang1, Hsiao-Jen Chung1,2*, I-Shen Huang1,2, Tzu-Ping Lin1,2, Eric Y.H. Huang1,2,
Shing-Hwa Lu2,3, Allen Wen-Hsiang Chiu4, William, J.S. Huang1,2
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.
2Department of Urology, School of Medicine, and Shu-Tien Urological Institute,
National Yang Ming Chiao Tung University, Taipei, Taiwan
3Taipei Veterans General Hospital, Taoyuan Branch
4Taipei City Hospital4
Purpose:
Robotic-assisted partial nephrectomy (RaPN) is widely performed for renal tumor and can preserve renal function. Renal artery pseudoaneurysm (RAP) is a potential life-threatening complication of partial nephrectomy. The goal of this study is to determinate the incidence of RAP after RaPN and identify the predictive factors, specifically focusing on those requiring management with embolization, and the effects of embolization on postsurgical renal function.
Material and Methods:
A retrospective review of the institutional robotic-assisted partial nephrectomy (RaPN) database was performed from December 2009 to June 2021. Renal artery pseudoaneurysm (RAP) was diagnosed by computed tomography angiography (CTA) for patients who were suspected of having RAP clinically. Patients who underwent embolization for RAP after RaPN represented a separated cohort to be compared with other patients (control). Patients’ demographic data, tumors’ characteristics, and operative outcomes were evaluated. Statistical analyses were used to determine the predictive factors of RAP after RaPN. The influence of embolization on the estimated glomerular filtration rate (eGFR) during the first postoperative year was also evaluated
Results:
A total of 544 patients who underwent RaPN was reviewed, and 14 patients (2.6%) developed RAP median of 9 days (interquartile range: 5 - 11 days) after surgery. Most those patients experienced gross hematuria and were diagnosed by CTA. No patients had recurrent RAP during follow-up after treatment (12 patients underwent embolization, and 2 patients underwent observation). No difference was found in age, body mass index (BMI), tumor size, total preoperative aspects and dimensions used for an anatomical (PADUA) scores, warm ischemia time, blood loss, intraoperative blood transfusion rates between patients who underwent embolization for RAP versus controls. However, male predominance (91.7% versus 59.4%, p = 0.024), higher total higher R.E.N.A.L Nephrometry Score (median 9.0 versus 8.0, p = 0.02), longer operative time (mean 349.6 mins versus 283.7 mins, p = 0.046) and longer postoperative hospital stays (median 6.0 days versus 5.0 days, p = 0.031) were noted in the patients who underwent embolization for RAP postoperatively. Besides, more proportion of patients who had 3 points N score (nearness to renal sinus or collecting system) in R.E.N.A.L score in embolization group, which reached statistically significance (p = 0.031). In the embolization group, the mean 3-day post-embolization eGFR was not different with the mean 3-day, 3-month, 6-month, and 12-month postoperative eGFR.
Conclusions:
The incidence of RAP is rare in our institute (2.6%). The occurrence of RAP is associated with male gender, higher R.E.N.A.L Score, longer operative time, and longer postoperative hospital stays. In nephrometry analysis, nearness of tumor to sinus or renal sinus involvement is associated with occurrence of RAP. Embolization is an effect treatment for RAP after RaPN, and post-embolization renal function was not deteriorated during the first postoperative year.
Keywords:
renal tumor, robotic-assisted partial nephrectomy, renal artery pseudoaneurysm, R.E.N.A.L Nephrometry Score, preoperative aspects and dimensions used for an anatomical (PADUA) score