Inci Kubilay, Cil Barbaros, Yazici Sertac, Peynircioglu Bora, Tan Bekir, Sahin Ahmet, Bilen Cenk Yucel
Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
J Endourol. 2010 Jan;24(1):149-54. doi: 10.1089/end.2009.0342.
We retrospectively reviewed the charts of patients with renal artery pseudoaneurysms (RAPs) to document their clinical presentation, surgical background, and outcome.
In all, 7 of the 1965 patients who underwent percutaneous stone surgery and 3 of the 25 patients who underwent laparoscopic nephron-sparing surgery had a diagnosis of RAP and were treated accordingly. The most common symptom was hematuria, which was classified as early or delayed according to the time of presentation, as mild, moderate, or severe according to the hemodynamics of the patient. In addition, angiographic images were reviewed, and the correlation between the clinical presentation of RAP and its location was investigated.
In the percutaneous stone surgery group, four patients experienced early mild to moderate hematuria and three experienced late moderate hematuria. All of the RAPs were located on the interlobar and arcuate arteries. In the laparoscopic nephron-sparing surgery group, one patient was asymptomatic, with diagnosis of renal-cell cancer recurrence at the 3-month follow-up, and had radical nephrectomy. Two patients presented with delayed moderate hematuria with lesions that were located on the interlobar, arcuate, and segmentary arteries. Two sessions of embolization were sufficient to stop bleeding in one patient with a segmentary artery aneurysm that had unfortunately lost kidney function during follow-up.
There is no predictive factor for patients undergoing percutaneous nephrolithotomy procedure yet, but laparoscopic partial nephrectomy for tumors localized in the central portion of kidney may end up with RAP especially if no adjuvant sealing agents are used. The outcome of RAPs depends primarily on early recognition and a high index of suspicion, which facilitates correct diagnosis and appropriate management. Selective angiography and embolization together is the gold standard, both for diagnosis and treatment.
我们回顾性分析了肾动脉假性动脉瘤（RAP）患者的病历，以记录其临床表现、手术背景及治疗结果。
在1965例行经皮肾镜取石术的患者中，有7例被诊断为RAP并接受了相应治疗；在25例行腹腔镜肾部分切除术的患者中，有3例被诊断为RAP并接受了相应治疗。最常见的症状是血尿，根据出现时间分为早期或延迟性血尿，根据患者血流动力学情况分为轻度、中度或重度血尿。此外，回顾了血管造影图像，并研究了RAP的临床表现与其位置之间的相关性。
在经皮肾镜取石术组中，4例患者出现早期轻度至中度血尿，3例出现晚期中度血尿。所有RAP均位于叶间动脉和弓状动脉。在腹腔镜肾部分切除术组中，1例患者无症状，在3个月随访时诊断为肾细胞癌复发，随后接受了根治性肾切除术。2例患者出现延迟性中度血尿，病变位于叶间动脉、弓状动脉和段动脉。对于1例段动脉动脉瘤患者，两次栓塞足以止血，但不幸的是该患者在随访期间肾功能丧失。
对于接受经皮肾镜取石术的患者，目前尚无预测因素，但对于位于肾脏中央部分的肿瘤行腹腔镜肾部分切除术可能会导致RAP，尤其是在未使用辅助封闭剂的情况下。RAP的治疗结果主要取决于早期识别和高度怀疑指数，这有助于正确诊断和适当处理。选择性血管造影和栓塞联合应用是诊断和治疗的金标准。
