Akiyama T, Samma S, Fujimoto K, Fukui Y, Hirayama A
Department of Urology, Nara-Prefectural Nara Hospital, Nara, Japan.
Int J Urol. 2001 Oct;8(10):568-71. doi: 10.1046/j.1442-2042.2001.00371.x.
With the increase in detection of incidental renal cell carcinoma, nephron-sparing surgery for small renal cell carcinomas is now recognized as one of the surgical options. We report a case of renal arteriovenous fistula developing after non-ischemic tumor enucleation of a small renal cell carcinoma using a microwave tissue coagulator. A 50-year-old Japanese man presented with right flank pain and gross hematuria. The patient had undergone non-ischemic tumor enucleation for right renal cell carcinoma, 2 cm in diameter, 1 month previously. Doppler ultrasound revealed the formation of an arteriovenous fistula at the enucleated portion. Transcatheter super-selective occlusion of the feeding artery was successfully performed with two metallic coils. The patient has been followed up with no sign of recanalization of the fistula. In this case, the tumor was located close to the renal hilus with thick arterial branches around the tumor. Additional microwave coagulations against arterial bleeding from the cutting surface might have been the cause of the fistula formation of this case. Non-ischemic tumor enucleation using a microwave tissue coagulator is a relatively easy and secure nephron-sparing surgical procedure. Excessive coagulation, however, should be avoided, since it might be the cause of unexpected postoperative vascular complications.
随着偶然发现的肾细胞癌检出率的增加，小肾细胞癌的保留肾单位手术现已被公认为手术选择之一。我们报告一例使用微波组织凝固器对小肾细胞癌进行非缺血性肿瘤剜除术后发生肾动静脉瘘的病例。一名50岁的日本男性出现右侧腰痛和肉眼血尿。该患者1个月前因直径2 cm的右肾细胞癌接受了非缺血性肿瘤剜除术。多普勒超声显示在剜除部位形成了动静脉瘘。使用两个金属线圈成功地对供血动脉进行了经导管超选择性闭塞。对该患者进行了随访，未见瘘管再通迹象。在本病例中，肿瘤位于肾门附近，肿瘤周围有粗大的动脉分支。对切割面动脉出血进行额外的微波凝固可能是本病例瘘管形成的原因。使用微波组织凝固器进行非缺血性肿瘤剜除术是一种相对简单且安全的保留肾单位手术。然而，应避免过度凝固，因为这可能是术后意外血管并发症的原因。
