机器人辅助部分肾切除术后无症状肾动脉假性动脉瘤的自然病史。

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy.

作者信息

Takayama Tatsuya, Fujita Akifumi, Sugihara Toru, Fujisaki Akira, Yamazaki Masahiro, Kameda Tomohiro, Kamei Jun, Ando Satoshi, Kurokawa Shinsuke, Fujimura Tetsuya

机构信息

Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan.

Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, Japan.

出版信息

Transl Androl Urol. 2021 Sep;10(9):3555-3565. doi: 10.21037/tau-21-384.

DOI:10.21037/tau-21-384

PMID:34733652

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8511543/

Abstract

BACKGROUND

We assessed the natural history of renal artery pseudoaneurysm (RAP) after robot-assisted partial nephrectomy (RAPN).

METHODS

From May 2016 to September 2020, 106 patients underwent RAPN for renal tumors at our institution. Among 100 patients, excluding 6 who were ineligible for contrast-enhanced computed tomography (CE-CT), 4 underwent renal artery selective embolization (RAE), of which 2 cases were emergency RAE within 7 days after RAPN and the other 2 were prophylactic RAE 8 or more days after RAPN. In 98 patients examined for the clinical course of asymptomatic RAP managed by surveillance, excluding the 2 who underwent emergency RAE, routine CE-CT was performed at 7 days, 1 month and 3 months after RAPN. Factors influencing the occurrence of RAP among these 98 patients, including the 2 who underwent emergency RAE and excluding the 2 who underwent prophylactic RAE, were analyzed by logistic regression analysis.

RESULTS

Median [interquartile range (IOR), range] observation period, age, radiographic tumor size, and maximum diameter of RAP were 20.8 (23.9, 3.0-57.6) months, 63 (18, 22-84) years, 23 (11, 9-48) mm, and 6.6 (5.2, 3.0-16.0) mm, respectively. CE-CT detected 28 RAPs in 23 (23.0%) of 100 patients by 7 days after RAPN and routine CE-CT detected 25 RAPs in 21 (21.4%) of 98 patients excluding 2 who underwent emergency RAE at 7 days after RAPN. RAP was diagnosed by routine CE-CT in 21 (21.4%), 1 (1.0%), and 0 (0%) patients at 7 days, 1 month, and 3 months after RAPN, respectively. In univariate analysis, age [odds ratio (OR) 0.144: 69-84 22-56 years old, P=0.0179], R.E.N.A.L [radius (tumor size as maximal diameter), exophytic/endophytic properties of tumor, nearness of tumor deepest portion to collecting system or sinus, anterior/posterior descriptor and location relative to polar line] nephrometry score (OR 1.374, P=0.0382), warm ischemic time (OR 1.085, P=0.0393), and renorrhaphy time (OR 1.055, P=0.0408) were significantly associated with the occurrence of RAP. In multivariate analysis, only age (OR 0.124, P=0.0148) was a significant factor.

CONCLUSIONS

Asymptomatic RAP up to 15 mm in diameter resolved spontaneously 3 months after RAPN. Young age (under 56 years) may be a factor in the development of RAP.

摘要

背景

我们评估了机器人辅助肾部分切除术（RAPN）后肾动脉假性动脉瘤（RAP）的自然病程。

方法

2016年5月至2020年9月，我院106例患者因肾肿瘤接受了RAPN。在100例患者中，排除6例不符合对比增强计算机断层扫描（CE-CT）条件的患者，4例接受了肾动脉选择性栓塞术（RAE），其中2例在RAPN后7天内进行了急诊RAE，另外2例在RAPN后8天或更长时间进行了预防性RAE。在98例接受观察管理的无症状RAP临床病程检查的患者中，排除2例接受急诊RAE的患者，在RAPN后7天、1个月和3个月进行了常规CE-CT检查。通过逻辑回归分析，分析了这98例患者（包括2例接受急诊RAE的患者，排除2例接受预防性RAE的患者）中影响RAP发生的因素。

结果

中位[四分位间距（IOR），范围]观察期、年龄、影像学肿瘤大小和RAP的最大直径分别为20.8（23.9，3.0 - 57.6）个月、63（18，22 - 84）岁、23（11，9 - 48）mm和6.6（5.2，3.0 - 16.0）mm。CE-CT在RAPN后7天内检测到100例患者中的23例（23.0%）有28个RAP，常规CE-CT在98例排除2例在RAPN后7天接受急诊RAE的患者中的21例（21.4%）检测到25个RAP。RAPN后7天、1个月和3个月，分别有21例（21.4%）、1例（1.0%）和0例（0%）患者通过常规CE-CT诊断出RAP。单因素分析中，年龄[比值比（OR）0.144：69 - 84岁对比22 - 56岁，P = 0.0179]、R.E.N.A.L[半径（肿瘤大小以最大直径计）、肿瘤的外生性/内生性特征、肿瘤最深部与集合系统或肾窦的接近程度、前后描述符以及相对于极线的位置]肾计量评分（OR 1.374，P = 0.0382）、热缺血时间（OR 1.085，P = 0.0393）和肾缝合时间（OR 1.055，P = 0.0408）与RAP的发生显著相关。多因素分析中，只有年龄（OR 0.124，P = 0.0148）是一个显著因素。