對鈍性腎臟創傷後腎血管栓塞的有無做核醫ERPF檢查評估長期性功能的影響
周聖峰、鄒頡龍、林維卿、蕭博任、八木橋祐亮
中國醫藥大學附設醫院泌尿部
中國醫藥大學附設醫院放射部
Long-term functional outcome by (Effective Renal Plasma Flow) ERPF after blunt renal trauma(BRT) with or without transarterial embolization (TAE)
1Sheng-Feng Chou, 1Chieh-Lung Chou, 2Wei-Ching Lin, 3Yusuke Yagihashi,
1Po-Jen Hsiao
1Department of Urology, China Medical University Hospital, Taichung, Taiwan
2Department of Radiology, China Medical University Hospital, Taichung, Taiwan
3Department of Urology, Okinawa Chubu Hospital, Okinawa, Japan
Purpose:
Transarterial embolization (TAE) has be documented as an efficient method for accurate hemostasis in blunt renal trauma(BRT). Main concern of embolization is devascularization of a portion of the renal parenchyma which may lead to decreased renal function. The main purpose of this study is to compare the deterioration of renal function after BRT between patients with and without TAE in recent decade from 2005 to 2015.
Materials and Methods:
We retrospectively reviewed the patient after BRT from January 2005 to December 2015, and follow up renal function at least one year after trauma with serum creatinine, grey-scale ultrasonography, and radioisotopic renography as 99mTc-mercapto-acetyl triglycine (MAG3). Inclusion criteria are patient after BRT with contrast CT in 48hrs after trauma. Exclusion criteria are other confounding factors that may cause decreased renal function, ESRD, and exploratory surgery.
Results:
Total case number is 10 and 11 patients in TAE group and non-TAE group. According to AAST classification, in TAE group and non-TAE group, grade I are registered as 0 case and 1 case, grade II as 1 and 1 case, grade III as 4 and 4 cases, grade IV as 5 and 5 case separately. Eight patients were treated in a single interventional session and two needed secondary TAE. Two of the TAE group became non-functional kidney according to ERPF report. ERPF in trauma side showed mean decreased uptake of MAG3 compared to non-affected side about 61.65 and 27.66% in TAE and non-TAE group with significant difference (p=0.002).
Conclusion:
TAE is an effective and minimally invasive treatment for BRT that can stop active bleeding and minimalize hemodynamic instability. However, potential damage cause by TAE compared to non-TAE group in same grading of JAST is significant. Adequate timing for TAE should be evaluated carefully for preserving renal function.