Qin Caipeng, Zhi Xin, Wang Fei, Li Qing, Gao Jian, Liu Shijun, Xu Tao
Department of Urology.
Department of Interventional Radiography, Peking University People's Hospital, the Second Clinical Medical College of Peking University, Beijing, China.
Medicine (Baltimore). 2021 Jan 22;100(3):e23581. doi: 10.1097/MD.0000000000023581.
Partial nephrectomy (PN) has been established as the standard treatment for T1 renal tumors, and postoperative hemorrhage due to vascular complications is a rare but potentially life-threatening complication reported after PN. Thus, this study evaluated the imaging and surgical factors associated with postoperative hemorrhage after PN and the clinical results of trans-arterial embolization. A retrospective review of the institutional PN database was performed from May 2012 to January 2019, revealing that we performed 810 PN procedures at our institution. In total, 12 patients were referred to the interventional radiology department for vascular complications after the procedure. Patients with and without transarterial embolization (TAE) were age- and sex-matched with 56 patients. Preoperative imaging characteristics and operative details were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of hemorrhage. Furthermore, renal functions at diagnosis, after operation or embolization for TAE cases, and at the last follow-up were recorded. A diagnosis of hemorrhage was made at a median of 4 (range, 0-25) days after surgery. The majority of patients (50%) presented with gross hematuria. T test revealed higher renal tumor-parenchyma contact area (TPA) (P = .0407), Length-A (P = .0136), Length-P (P = .0267), operation time (P = .0214) and estimated blood loss (P = .0043) in patients with hemorrhage than in controls. Binary logistic regression analysis identified TPA (P = .048) and estimated blood loss (P = .042) as independent predictors for postoperative hemorrhage with an area under the ROC curve of 0.705 (64% sensitivity and 79% specificity). In conclusion, the occurrence of hemorrhage after PN was associated with a larger TPA and more estimated blood loss during the procedure. In patients who underwent selective TAE, renal function remained comparable with that of controls.
部分肾切除术（PN）已成为T1期肾肿瘤的标准治疗方法，PN术后因血管并发症导致的出血是一种罕见但可能危及生命的并发症。因此，本研究评估了与PN术后出血相关的影像学和手术因素以及经动脉栓塞的临床结果。对2012年5月至2019年1月期间机构PN数据库进行回顾性分析，结果显示我们机构共进行了810例PN手术。总共有12例患者在术后因血管并发症被转诊至介入放射科。接受和未接受经动脉栓塞（TAE）的患者在年龄和性别上与56例患者相匹配。考虑了术前影像学特征和手术细节。采用单变量和多变量分析来检验它们与出血发生的最终关联。此外，记录了TAE病例诊断时、手术或栓塞后以及最后一次随访时的肾功能。出血诊断在术后中位时间4天（范围0 - 25天）做出。大多数患者（50%）出现肉眼血尿。T检验显示出血患者的肾肿瘤-实质接触面积（TPA）（P = 0.0407）、长度-A（P = 0.0136）、长度-P（P = 0.0267）、手术时间（P = 0.0214）和估计失血量（P = 0.0043）均高于对照组。二元逻辑回归分析确定TPA（P = 0.048）和估计失血量（P = 0.042）是术后出血的独立预测因素，ROC曲线下面积为0.705（敏感性64%，特异性79%）。总之，PN术后出血的发生与更大的TPA和手术过程中更多的估计失血量相关。接受选择性TAE的患者肾功能与对照组相当。
