肾癌药理冷缺血条件下体外切除原位再植肾的方法

封面


如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

研究现实性：提高肾癌患者的治疗效果是肿瘤学的主要问题之一。在其解决方案中，高度重视新外科技术的发展。

本研究的目的是评估肾癌患者在冷缺血条件下进行体外肾切除术并原位再植的结果。

材料与方法。这项研究包括44名肾癌患者，包括31名男性（70.5%），13名女性（29.5%）。所有患者在2012和2021之间进行治疗。患者的平均年龄为55,92±12,6岁。TNM分期：Ca1—3bN0M0-1 G1-3。 75%（33）的患者诊断为pT1a-1b期；pT2a–2b—在11.4%（5）中，一名患者发现多处病变；pT3a–3b—在13.6%（6）中，一名患者的单个肾脏最多有15处病变；两名手术患者患有单发肾癌并有腔内侵犯。肾计量指数R.E.N.A.L.—10.32的平均得分±1.34.

结果。手术时间为402.07±83.21分钟。冷缺血持续时间为149.9±53.1分钟。失血量-751.1±633.6毫升。13例患者进行了肾血管修复术。根据Clavien–Dindo分类，在16名(36.6%)患者中检测 到了II级以上的术后并发症。术后第4天因肠系膜血栓形成而致死的结果只有1例。3例(6.8%)病例出现疾病进展。术前肾小球滤过率水平平均为72.3±16.8毫升/(分钟·1.73平方米)，术后早期为58.7±28.3毫升/(分钟·1.73平方米)，术后1年为69.4±26.2毫升/(分钟1.73平方米）。随访时间为8至 86个月(平均58.7±19.1/月）。这些患者的五年总生存率为91%，癌症特异性生存率为93%。

结论。该技术适用于多个病灶、位于中心的大肿瘤、难以到达的定位，以及不可能发生体内药理缺血和器官血液供应特殊性的患者。

全文:

受限制的访问

作者简介

Irina V. Miroshkina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: homa0308@gmail.com
ORCID iD: 0000-0002-3208-198X
SPIN 代码: 8036-4759
Scopus 作者 ID: 57194755893

Junior Researcher

俄罗斯联邦, Moscow

Tatyana P. Baytman

A.V. Vishnevsky National Medical Research Center of Surgery

Email: bit.t@mail.ru
ORCID iD: 0000-0002-3646-1664
SPIN 代码: 4684-3230
Scopus 作者 ID: 57219438104

Postgraduate student

俄罗斯联邦, Moscow

Zholboldu Polotbek uulu

A.V. Vishnevsky National Medical Research Center of Surgery

Email: jolboldu94.01@gmail.com
ORCID iD: 0000-0002-2424-0493

Junior Researcher

俄罗斯联邦, Moscow

Vardan A. Oganyan

A.V. Vishnevsky National Medical Research Center of Surgery

Email: vardan_94@mail.ru
ORCID iD: 0000-0002-2059-8703

Junior Researcher

俄罗斯联邦, Moscow

Alina A. Chevina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: a.chevina@mail.ru
ORCID iD: 0000-0001-8066-2626

anesthesiologist-resuscitator

俄罗斯联邦, Moscow

Vlada Yu. Raguzina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: vlada94@bk.ru
ORCID iD: 0000-0002-1527-670X
SPIN 代码: 8150-7336
Scopus 作者 ID: 57223053364

Junior Researcher

俄罗斯联邦, Moscow

Anton D. Simonov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: simonov.anton.md@gmail.com
ORCID iD: 0000-0003-3202-6873

clinical resident

俄罗斯联邦, Moscow

Alexey V. Chzhao

A.V. Vishnevsky National Medical Research Center of Surgery

Email: chzhao@ixv.ru
ORCID iD: 0000-0002-0204-8337
SPIN 代码: 1101-6874

Doc. Sci. (Med.), Professor, Head of the Oncology Department

俄罗斯联邦, Moscow

Alexander A. Pranovich

A.V. Vishnevsky National Medical Research Center of Surgery

编辑信件的主要联系方式.
Email: pranovich@ixv.ru
ORCID iD: 0000-0002-6034-9269
SPIN 代码: 1096-6331

Cand. Sci. (Med.), Senior Researcher

俄罗斯联邦, Moscow

参考

  1. Ljungberg B, Campbell SC, Choi HY, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60:615–621. doi: 10.1016/j.eururo.2011.09.001
  2. Kaprin AD, Starinskiy VV, Petrova GV, editors. Zlokachestvennye novoobrazovanija v Rossii v 2017 godu (zabolevaemost’ i smertnost’). Moscow; 2018. 250 p. (In Russ.)
  3. Gill IS, Kavoussi LR, Lane BR, Blute ML, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. Journal of Urology. 2007;178(1):41–46. doi: 10.1016/j.juro.2007.03.038
  4. Simhan J, Smaldone MC, Tsai KJ, et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol. 2011;60(4):724–730. doi: 10.1016/j.eururo.2011.05.030
  5. Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: the 2014 update. European Urology. 2015;67(5):913–924. doi: 10.1016/j.eururo.2015.01.005
  6. Crispen PL, Greenberg RE, Chen DYT, Uzzo RG. Аctive surveillance of enhancing renal tumors. Oncourology. 2007;(4):17–21.
  7. Komyakov BK, Zamyatnin SA, Novikov AI, et al. Extracorporeal partial nephrectomy for neoplasm. Urologiia. 2013;(4):60–63. (In Russ.)
  8. Zotikov AE, Adyrkhaev ZA, Teplov AA, et al. Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment. Angiology and Vascular Surgery. 2017;23(2):118–125. (In Russ.)
  9. Gritskevich AA, Miroshkina IV, Piyanikin SS, et al. Extracorporeal partial nephrectomy under pharmaco-cold ischemia for renal cell carcinoma. Pirogov Russian Journal of Surgery. 2017;(1):42–47. doi: 10.17116/hirurgia2017142-47 (In Russ.)
  10. Kulisa M, Bensouda A, Vaziri N, et al. Complex renal tumors on solitary kidney: results of ex vivo nephron-sparing surgery with autotransplantation. Prog Urol. 2010;20(3)194–203. doi: 10.1016/j.purol.2009.10.019
  11. Gritskevich AA, Miroshkina IV, Baitman TP, et al. Extracorporeal partial nephrectomy during pharmaco-cold ischemia in patients with renal cell carcinoma: history and current problems. Experimental and Clinical Urology. 2019;(4):32–39. doi: 10.29188/2222-8543-2019-11-4-32-39 (In Russ.)
  12. Matveev VB, Perlin DV, Figurin KM, Volkova MI. Organosohranjajushhee lechenie raka pochki. Prakticheskaja onkologija. 2005;6(3):162–166. (In Russ.)
  13. Gritskevich AA, Pyanikin SS, Makrushin MS, et al. Extracorporeal resection of solitary kidney with trombectomy from the vena cava inferior with orthotopic replantation of the vessels in patient with renal cancer. Experimental and Clinical Urology. 2015;(3):132–137. (In Russ.)
  14. . Gritskevich AA, P’yanikin SS, Adyrkhaev ZA, et al. Ex vivo kidney resection in pharmacological cold ischemia followed by orthotopic autotransplantation. Transplantologiya. 2016;(3):27–36. (In Russ.)
  15. Association of urology. TNM classification tumor of kidney. Guidelines. EAU; 2017;14–15.
  16. Miroshkina IV, Grickevich AA, Baytman TP, et al. The role of markers of acute kidney damage in assessing kidney function with its ischemia. Experimental and Clinical Urology. 2018;(4):114–121. (In Russ.)
  17. Kim SP, Thompson RH, Boorjian SA, Weight CJ, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012;188(1):51–57. doi: 10.1016/j.juro.2012.03.006
  18. Teplov AA, Gritskevich AA, Pyanikin SS, et al. Extracorporeal resection of the kidney in the setting of the pharmacological and cold temperature ischemia with orthotopic replantation of the vessels without ureter transaction in patients with renal cell carcinoma. Experimental and Clinical Urology. 2015;(2):52–63. (In Russ.)
  19. Shuch B, Hanley J, Lai J, et al. Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer. 2013;119(16):2981–2989. doi: 10.1002/cncr.28141
  20. Tobert CM, Riedinger CB, Lane BR. Do we know (or just believe) that partial nephrectomy leads to better survival than radical nephrectomy for renal cancer? World J Urol. 2014;32(3):573–579. doi: 10.1007/s00345-014-1275-8
  21. Arnold ML, Thiel DD, Diehl N, et al. Comparison of baseline quality of life measures between renal cell carcinoma patients undergoing partial versus radical nephrectomy. BMC Urology. 2013;13:52. doi: 10.1186/1471-2490-13-52
  22. Kaushik D, Kim SP, Childs MA, et al. Overall survival and development of stage IV chronic kidney disease in patients undergoing partial and radical nephrectomy for benign renal tumors. European Urology. 2013;64(4):600–606. doi: 10.1016/j.eururo.2012.12.023
  23. Mano R, Kent M, Larish Y, et al. Partial and Radical Nephrectomy for Unilateral Synchronous Multifocal Renal Cortical Tumors. Urology. 2015;85(6):1404–1410. doi: 10.1016/j.urology.2015.02.032
  24. Yasuda Y, Yuasa T, Yamamoto S, et al. Evaluation of the RENAL nephrometry scoring system in adopting nephron-sparing surgery for cT1 renal cancer. Urol Int. 2013;90(2):179–183. doi: 10.1159/000342971
  25. An JY, Ball MW, Gorin MA, Hong JJ. Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes. Urology. 2017;100:151–157. doi: 10.1016/j.urology.2016.10.047
  26. Kunath F, Schmidt St, Krabbe LM, et al. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev. 2017;5(5): CD012045. doi: 10.1002/14651858.CD012045
  27. Streja E, Kalantar-Zadeh K, Molnar MZ, et al. Radical versus partial nephrectomy, chronic kidney disease progression and mortality in US veterans. Nephrol Dial Transplant. 2018;33(1):95–101. doi: 10.1093/ndt/gfw358
  28. Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–552. doi: 10.1016/j.eururo.2010.12.013
  29. Zini L, Perrotte P, Capitanio U, et al. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer. 2009;115(7):1465–1471. doi: 10.1002/cncr.24035
  30. Tan HJ, Norton EC, Ye Z, et al. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012;307(15):1629–1635. doi: 10.1001/jama.2012.475
  31. Patel HD, Kates M, Pierorazio PM, et al. Balancing cardiovascular (CV) and cancer death among patients with small renal masses: modification by CV risk. BJU Int. 2014;115(1):58–64. doi: 10.1111/bju.12719
  32. Shuch B, Hanley J, Lai J, et al. Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer. 2013;119(16):2981–2989. doi: 10.1002/cncr.28141
  33. Kates M, Badalato GM, Pitman M, et al. Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol. 2011;186(4):1247–1253. doi: 10.1016/j.juro.2011.05.054
  34. Huang WC, Elkin EB, Levey AS, et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors – is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181(1):55–61. doi: 10.1016/j.juro.2008.09.017

补充文件

附件文件
动作
1. JATS XML
下载
2. 图.1.在装有碎冰的托盘中的横切血管上动员肾脏 Fig. 1. The mobilized kidney on the crossed vessels in a tray with ice crumbs

下载 (167KB)
索引源数据
3. 图.2.健康组织内的肿瘤切除。1—肾脏的创面；2—聚集性多发肿瘤 Fig. 2. Resection of a tumor within healthy tissues. 1 – wound surface of the kidney; 2 – conglomerate multiple tumor

下载 (183KB)
索引源数据
4. 图.3.肾脏集合系统的重建 Fig. 3. Reconstruction of the collecting system of the kidney

下载 (121KB)
索引源数据
5. 图.4.移植肾。1—肾静脉残端与下腔静脉之间的静脉-静脉吻合；2—肾动脉残端和主动脉之间的血管吻合 Fig. 4. Reimplanted kidney. 1 – venovenous anastomosis between the renal vein stump and the inferior vena cava; 2 – vascular anastomosis between the renal artery stump and the aorta

下载 (200KB)
索引源数据
6. 图.5.根据Clavien–Dindo分类根据严重程度的术后并发症分布 Fig. 5. Distribution of postoperative complications according to the severity according to the Clavien – Dindo classification

下载 (51KB)
索引源数据

版权所有 © Eco-Vector, 2021


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 89281 от 21.04.2025.