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Abstract：
While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.
摘要：
虽然部分肾切除术提供肿瘤疗效并保留T1肾肿瘤的肾功能，肾动脉假性动脉瘤(RAP)仍然是一种罕见但可能危及生命的并发症.这项研究比较了机器人辅助(RAPN)的RAP发生率，腹腔镜（LPN），大型三级肿瘤中心的开放性（OPN）部分肾切除术。这项回顾性研究分析了2012年至2022年间785例接受肾部分切除术的患者(398RAPN，122LPN,265OPN)。数据包括人口统计，肿瘤大小/位置，手术类型,临床表现,治疗,和术后结果。主要结果是RAP发生率，次要结果包括演示，治疗功效,和肾功能。17名患者（2.1％）发生了RAP，表现为大量血尿（100％），失血性休克(5.8%),和凝块保留（23％）。中位发病时间为术后12天。RAP发生在4（1％），4（3.3%），和9例(3.4%)患者在RAPN后，LPN,OPN,分别(p=0.04)。只有手术长度和手术方式与RAP独立相关。选择性栓塞术后即刻出血控制达94%,一名患者需要第二次栓塞。不需要额外的手术或肾切除术。两组在一年时估计的GFR相似(p=0.53)。与LPN和OPN相比，RAPN的RAP发生率明显较低（p=0.04）。急诊血管造影栓塞被证明是有效的，对肾功能无长期影响。这项回顾性研究缺乏随机化和长期随访。有必要对更大的数据集和更长的随访进行进一步的研究。这项研究表明，与传统方法相比，机器人辅助肾部分切除术与RAP的风险显着降低相关。急诊栓塞可有效治疗RAP，而不会损害长期肾功能。
