肾细胞癌的肾切开切除术

S. Shkodkin, Y. Idashkin, S. A. Fironov, V. V. Fentisov, A. Udovenko
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引用次数: 5

摘要

介绍。一般认为肾切除术的关键时刻是缺血和止血充分的时间。到目前为止,保留肾单元治疗的主要禁忌症之一是不能提供中间节段肿瘤的止血,特别是当它们是肾内的。研究目的。目的:评价开腹肾切除术的疗效。材料和方法。2005年至2018年,我们为肾细胞癌进行了152例开放式部分肾切除术(OPN)。OPN算法在热缺血条件下,采用腹膜外第IX肋间隙腰腹入路并切除X肋切除压迫血管,92.8%的病例完成了节段性或异常动脉的夹持。手术切除肿瘤,在未改变的肾实质内退0.5-1 cm。结果患者平均年龄55.4±16.2岁;男女比例为52.6/47.4%;右侧/左侧肿瘤定位分别为42.1/57.9%。手术时间109.6±56.7 min,局部缺血时间15.1±8.3 min,失血量258±93 ml,术后4 ~ 12 h,平均为35.7±22.1 ml, 24 h后激活,拔除导尿管,59例(38.8%)患者未行膀胱引流。术后平均住院时间为10.1±4.2天/天。结论:从可见肿瘤的边缘处开窗切除肾脏,并对手术边缘进行视觉控制,可提供良好的肿瘤学效果,不需要“快速”组织学,在形态学尺度上计算,是并发症高风险患者肾切除术的一种替代方法。披露:该研究没有赞助。作者声明无利益冲突。
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KIDNEY OPEN RESECTION IN RENAL CELL CARCINOMA
Introduction.Generally recognized critical moments in kidney resection are the time of ischemia and the adequacy of hemostasis. Until now, one of the main contraindications to nephron-sparing treatment is the inability to provide hemostasis in middle-segment tumors, especially when they are intrarenal.Purpose of research.To evaluate the effectiveness of open resection of the kidney.Materials and methods.For the period 2005 to 2018 us made 152 open partial nephrectomy (OPN) for renal cell carcinoma. The algorithm OPN included extra peritoneal lumbotome access in the IX intercostal space with resection of the X rib resection under conditions of warm ischemia for compression of the blood vessel, in 92.8% of cases completed the clamping of segmental or aberrant arteries. Resection was performed, retreating from the tumor 0.5-1 cm within the unchanged renal parenchyma.Results.The mean age of patients was 55.4±16.2 years; male/female ratio was 52.6/47.4%; right-sided/ left-sided tumor localization was 42.1/57.9%, respectively. The duration of the operation was 109.6±56.7 min, the time of partial ischemia was 15.1±8.3 min, the volume of blood loss was 258±93 ml the Discharge along the drains lasted for 4-12 hours after the operation and averaged 35.7±22.1 ml. Patients were activated after 24 hours, when the urethral catheter was removed, in 59 (38.8%) cases, bladder drainage was not performed. Average postoperative hospital stay was 10.1±4.2 per day.Conclusion.The technique of open resection of the kidney with a margin from the border of the visible tumor and visual control of the surgical edge provides good oncological results, does not require the «Express» histology and is an alternative to nephrectomy in patients with high risk of complications, calculated on morphometric scales.Disclosure: The study did not have sponsorship. The authors declare no conflict of interest.
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