機器人手臂協助部分腎臟切除後的腎動脈假性血管瘤：單一醫學中心預測因子分析
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
Renal Arterial Pseudoaneurysm After Robotic-assisted Partial Nephrectomy: Single-Center Analysis of Predictive Factors
Yu-Pin Huang1, Hsiao-Jen Chung1,2*, Yi-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 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.
Material and Methods:
A retrospective review of the institutional robotic-assisted partial nephrectomy (RaPN) database was performed from December 2009 to August 2020. Renal artery pseudoaneurysm (RAP) was diagnosed by computed tomography angiography (CTA) for patients who were suspected of having RAP clinically. Patients who had RAP after RaPN were compared with other patients who did not have RAP. Patients’ demographic data, tumors’ characteristics, and operative outcomes were evaluated. Statistical analyses were used to determine the predictive factors of RAP after RaPN.
Results:
A total of 473 patients who underwent RaPN was reviewed, and 10 patients (2.1%) developed RAP median of 10 days (interquartile range: 6 - 14.5 days) after surgery. Most those patients experienced gross hematuria and were diagnosed by CTA. No patients had recurrent RAP during follow-up after treatment (8 patients underwent embolization, 1 patient underwent exploratory laparotomy, and 1 patient 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, total operative time, warm ischemia time, blood loss, intraoperative blood transfusion rates between patients who had RAP versus controls. However, higher total higher R.E.N.A.L Nephrometry Score (median 9.0 versus 8.0, p = 0.038), more renal sinus involvement in PADUA score (median 2.0 versus 1.0, p = 0.045) and longer postoperative hospital stays (median 6.0 days versus 5.0 days, p = 0.014) were noted in the patients who had developed 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 RAP group, which reached statistically significance (p = 0.042).
Conclusions:
The incidence of RAP is rare in our institute (2.1%). The occurrence of RAP is associated with higher R.E.N.A.L Score, and longer postoperative hospital stays. In nephrometry analysis, nearness of tumor to sinus or renal sinus involvement is associated with occurrence of RAP.
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