选择性经动脉栓塞治疗医源性血管损伤对部分肾切除术后整体肾功能无影响。

Selective Trans-arterial Embolization of Iatrogenic Vascular Lesions Did Not Influence the Global Renal Function After Partial Nephrectomy.

机构信息

Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France.

出版信息

Urology. 2020 Jul;141:108-113. doi: 10.1016/j.urology.2020.03.036. Epub 2020 Apr 10.

DOI:10.1016/j.urology.2020.03.036

PMID:32283170

Abstract

OBJECTIVE

To evaluate the renal function outcomes after selective trans-arterial embolization (SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous fistula, following partial nephrectomy (PN).

MATERIALS AND METHODS

A multi-institutional study was conducted including consecutive patients who underwent PN between January 2009 and March 2019. Two surgical approaches were used: open and robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance, RENAL score, and tumor size. The primary outcome was the evolution of global renal function at 6-months postoperatively.

RESULTS

A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included. IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical approach (P = .78). Patients from embolization group were matched to 34 cases without postoperative IVL. Groups were comparable concerning clinical, tumor and surgical characteristics. The clinical success of SAE, defined as the absence of recourse to a second embolization or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR) was similar between control group (93 [85-102] ml/min) and embolization group (95 [83-102] ml/min) (P = .99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference (P = .73).

CONCLUSION

IVL are rare complications of PN. SAE is an effective and minimally invasive management tool, with no deleterious effect on global renal function.

摘要

目的

评估肾部分切除术后（PN）发生医源性血管病变（IVL）（包括假性动脉瘤和动静脉瘘）后选择性经动脉栓塞（SAE）的肾功能结局。

材料和方法

这是一项多机构研究，纳入了 2009 年 1 月至 2019 年 3 月期间接受 PN 的连续患者。使用了两种手术方法：开放性 PN 和机器人辅助 PN。确定并匹配（1:2）发生 SAE 的患者与没有 IVL 的患者。匹配标准为年龄、性别、Charlson 评分、肌酐清除率、RENAL 评分和肿瘤大小。主要结局是术后 6 个月时整体肾功能的演变。

结果

共纳入 493 例连续 PN（360 例开放性 PN 和 133 例机器人辅助 PN）。IVL 发生率为 17 例（3.4%），与手术方法无统计学差异（P=0.78）。栓塞组的患者与 34 例术后无 IVL 的患者相匹配。两组在临床、肿瘤和手术特征方面具有可比性。SAE 的临床成功率（定义为无需再次栓塞或全肾切除术）在 16 例（94.1%）中获得。SAE 后无轻微或严重并发症报告。对照组（93 [85-102] ml/min）和栓塞组（95 [83-102] ml/min）术前估算肾小球滤过率（eGFR）相似（P=0.99）。对照组（87 [72-95] ml/min）和栓塞组（83 [76-93] ml/min）在 6 个月随访时的中位（IQR）eGFR 无显著差异（P=0.73）。