病例報告: 達文西機器人輔助部分腎臟切除後的巨大假性動脈瘤

何肇晏¹、林宜佳^1,3、盧大年²、黃一勝^{1,3, 4}

¹新光吳火獅紀念醫院 外科部 泌尿科，²放射科，³輔仁大學醫學院，²台北醫學大學泌尿科

Chao-Yen Ho¹, Yi-Chia Lin^1,3, Ta-Nien Lu², Thomas I.S. Hwang^1,3,4

¹Division of Urology, Department of Surgery, ²Department of Radiology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan, ³School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, ⁴Department of Urology, Taipei Medical University

 

Partial nephrectomy (PN) is the standard treatment option for patients with small renal mass, such as clinical T1a to T1b renal tumors. Compared with radical nephrectomy, PN is a more complicated procedure with involvement of both vascular and collecting systems, and complications can occur. The incidence of renal artery pseudoaneurysm(RAP) after PN is between 0.4% and 2%. Minimally invasive procedures, such as laparoscopic or robotic-assisted approaches have a higher incidence of RAP when compared with open PN.

Here we present a 63-year-old male with incidentally finding of a right renal tumor, clinical stage of T1bN0M0. He underwent a robot-assisted laparoscopic partial nephrectomy (RAPN). The patient tolerated the procedure well and was discharged uneventfully. The pathology report showed a papillary renal cell carcinoma, pT1bNxMx, Fuhrman grade II, with a negative surgical margin. However, the patient presented to ER with intermittent gross hematuria aggravated since one month after the operation. Contrast enhanced computerized tomography (CT) scan demonstrated a large pseudoaneurysm of 5 × 4.4 × 3.9 cm in size over the posterior part of the right kidney at the incision site. Transfemoral renal angiography performed by a radiologist demonstrated a huge pseudoaneurysm from the posterior branches of the right renal artery. Selective embolization was performed with coils, glue and gel-foam cubes. The patient tolerated the procedure well and was discharged uneventfully.