83 research outputs found
Π Π΅ΡΠΈΠ΄ΠΈΠ² ΡΠ°ΠΊΠ° ΠΏΠΎΡΠΊΠΈ: ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΡ ΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ (ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ)
In the last ten years, the number of organ preservation surgeries for kidney cancer significantly increased. Per literature data, the incidence of recurrences after partial nephrectomy is between 2.9 and 11 %, mostly they are located in the operated or contralateral kidney. Positive surgical margin, high stage and histological subtype of the tumor, as well as hereditary diseases, can serve as predictors for recurrences. In renal cancer recurrences, radical nephrectomy, ablation therapy and repeat tumor resection are possible treatment methods. Kidney resection, same as in primary renal tumors, leads to chronic kidney disease and cardiovascular complications. Different ablation methods, despite their low invasiveness, are not always technically possible. Therefore, in patients with kidney cancer recurrence and satisfactory functional status, repeat partial nephrectomy can be a method of choice. The literature describes the outcomes of open repeat kidney resection with high incidence of general and severe complications. The number of these complications significantly decreased due to the use of robot-assisted access for resection of recurrent renal tumors. Functional characteristics of repeat kidney resections do not significantly decrease, especially in robot-assisted partial nephrectomy. Oncological outcomes of these surgeries remain intermediate, further prospective multi-center trials are needed for their confirmation.ΠΠ° ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅Π΅ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠΈΠ΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½ΡΡΡΠΈΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΠΏΡΠΈ ΡΠ°ΠΊΠ΅ ΠΏΠΎΡΠΊΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠ²Π΅Π»ΠΈΡΠΈΠ»ΠΎΡΡ. ΠΠΎ Π΄Π°Π½Π½ΡΠΌ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ, ΠΏΠΎΡΠ»Π΅ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ ΡΠ°ΡΡΠΎΡΠ° ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠ² ΠΊΠΎΠ»Π΅Π±Π»Π΅ΡΡΡ ΠΎΡ 2,9 Π΄ΠΎ 11 %, Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΌ ΠΎΠ½ΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΡΡΡΡΡ Π² ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΈΠ»ΠΈ ΠΊΠΎΠ½ΡΡΠ°Π»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠΊΠ΅. ΠΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΈΡ
ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΌΠΎΠ³ΡΡ Π±ΡΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΊΡΠ°ΠΉ, Π²ΡΡΠΎΠΊΠ°Ρ ΡΡΠ°Π΄ΠΈΡ ΠΈ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠΎΠ΄ΡΠΈΠΏ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΡΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΡΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π°Ρ
ΡΠ°ΠΊΠ° ΠΏΠΎΡΠΊΠΈ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½Ρ ΡΠ°ΠΊΠΈΠ΅ Π²Π°ΡΠΈΠ°Π½ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΠΊΠ°ΠΊ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ, Π°Π±Π»Π°ΡΠΈΠΎΠ½Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ ΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ. Π£Π΄Π°Π»Π΅Π½ΠΈΠ΅ ΠΏΠΎΡΠΊΠΈ, ΠΊΠ°ΠΊ ΠΈ ΠΏΡΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΡ
ΡΠ΅Π½Π°Π»ΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ
, Π²Π΅Π΄Π΅Ρ ΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠΎΡΠ΅ΠΊ ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. Π Π°Π·Π»ΠΈΡΠ½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π°Π±Π»Π°ΡΠΈΠΈ, Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΈΡ
ΠΌΠ°Π»ΠΎΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΡΡΡ, Π½Π΅ Π²ΡΠ΅Π³Π΄Π° ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈ Π²ΡΠΏΠΎΠ»Π½ΠΈΠΌΡ. ΠΠΎΡΡΠΎΠΌΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠΌ ΡΠ°ΠΊΠ° ΠΏΠΎΡΠΊΠΈ ΠΈ Π½Π΅ΠΎΡΡΠ³ΠΎΡΠ΅Π½Π½ΡΠΌ ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΡΠ°ΡΡΡΠΎΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ Π²ΡΠ±ΠΎΡΠ° ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΏΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ. Π Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅ ΠΎΠΏΠΈΡΠ°Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΎΡΠΊΡΡΡΠΎΠΉ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ ΠΏΠΎΡΠΊΠΈ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ ΡΠ°ΡΡΠΎΡΠΎΠΉ ΠΎΠ±ΡΠΈΡ
ΠΈ ΡΠ΅ΡΡΠ΅Π·Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ. ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΡΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠΌΠ΅Π½ΡΡΠΈΠ»ΠΎΡΡ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΎΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ° Π΄Π»Ρ ΡΠ΄Π°Π»Π΅Π½ΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ
ΡΠ΅Π½Π°Π»ΡΠ½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ. Π€ΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΏΠΎΡΠ»Π΅ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΡ
ΡΠ΅Π·Π΅ΠΊΡΠΈΠΉ ΠΏΠΎΡΠΊΠΈ ΡΡ
ΡΠ΄ΡΠ°ΡΡΡΡ Π½Π΅Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ ΠΏΡΠΈ ΡΠΎΠ±ΠΎΡ-Π°ΡΡΠΈΡΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ. ΠΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π΄Π°Π½Π½ΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ ΡΠ²Π»ΡΡΡΡΡ Π΅ΡΠ΅ ΠΏΡΠΎΠΌΠ΅ΠΆΡΡΠΎΡΠ½ΡΠΌΠΈ, Π΄Π»Ρ ΠΈΡ
ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½ΠΈΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΡ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠΈΠ΅ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ
Π ΠΎΠ±ΠΎΡ-Π°ΡΡΠΈΡΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΏΠΎΠ²ΡΠΎΡΠ½Π°Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ ΠΎΠΏΡΡ ΠΎΠ»Π΅ΠΉ ΠΏΠΎΡΠΊΠΈ
Background. Currently, organ-preserving surgery of kidney tumors often involves robot-assisted access. It can also be used in partial nephrectomy in patients with local recurrence after previous resection.Aim. To evaluate the effectiveness of repeat robot-assisted partial nephrectomy of recurrent kidney tumors.Materials and methods. At the Urology Center of the Mariinsky Hospital (Saint Petersburg) between 2018 and 2022 robot-assisted partial nephrectomy was performed in 86 patients (46 (59.5 %) men and 40 (40.5 %) women) with stage Π’1Π° (n = 72) and Tib (n = 14) kidney tumors. Mean patient age was 58.0 Β± 8.5 years, tumor size varied between 1.2 and 5.2 cm. Seven (7) patients were operated on due to tumor recurrence after previously performed partial nephrectomy. In all cases, lesion was located outside the site of primary resection. Mean time between the 1st and 2nd surgeries was 24 (12-46) months. Histological examination of primary tumor showed renal cell carcinoma in 4 patients, papillary carcinoma in 2 patients, chromophobe carcinoma in 1 patient. In 5 patients, one recurrent lesion was diagnosed, in 2 patients - two. Ligation of the renal artery was performed in 2 patients, its branch - in 3, ischemia-free resection - in 2 patients. Evaluation of mean operating time, blood loss volume, warm ischemia time, pre- and postoperative kidney function was performed.Results. Mean operating time of repeat partial nephrectomy was 180 (130-210) minutes. Warm ischemia time for renal artery ligation was 16 and 20 minutes, for selective ischemia 14, 18 and 24 minutes. Mean blood loss volume was 220 (80-650) ml. No intraoperative complications were observed, grade I-II postoperative complications per the Clavien classification were observed in 2 patients. Mean decrease in glomerular filtration time was 8 % (from 62 to 54 mL/min/1.73 m2). During 16-month follow up period, tumor recurrence was not observed.Conclusion. Robotic access allows to safely and effectively perform resection of recurrent kidney tumors with satisfactory functional and intermediate oncological outcomes.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΏΡΠΈ ΠΎΡΠ³Π°Π½ΠΎΡΠΎΡ
ΡΠ°Π½ΡΡΡΠ΅ΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ ΠΏΠΎΡΠΊΠΈ Π°ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ ΡΠΎΠ±ΠΎΡ-Π°ΡΡΠΈΡΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π΄ΠΎΡΡΡΠΏ. Π’Π°ΠΊΠΆΠ΅ Π΅Π³ΠΎ ΠΌΠΎΠΆΠ½ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ ΠΏΡΠΈ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΌΠ΅ΡΡΠ½ΡΠΌ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΎΠΌ ΠΏΠΎΡΠ»Π΅ ΠΏΡΠ΅Π΄ΡΠ΄ΡΡΠ΅ΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ - ΠΎΡΠ΅Π½ΠΊΠ° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ ΡΠΎΠ±ΠΎΡ-Π°ΡΡΠΈΡΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ ΠΏΠΎΡΠΊΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΠ΅Π½ΡΡΠ΅ ΡΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΠ°ΡΠΈΠΈΠ½ΡΠΊΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ (Π‘Π°Π½ΠΊΡ-ΠΠ΅ΡΠ΅ΡΠ±ΡΡΠ³) Ρ 2018 ΠΏΠΎ 2022 Π³. ΡΠΎΠ±ΠΎΡ-Π°ΡΡΠΈΡΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° 86 Π±ΠΎΠ»ΡΠ½ΡΠΌ (46 (59,5 %) ΠΌΡΠΆΡΠΈΠ½Π°ΠΌ ΠΈ 40 (40,5 %) ΠΆΠ΅Π½ΡΠΈΠ½Π°ΠΌ) Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ ΠΏΠΎΡΠΊΠΈ ΡΡΠ°Π΄ΠΈΠΉ Π’1Π° (n = 72) ΠΈ T1b (n = 14). Π‘ΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎΡΡΠ°Π²ΠΈΠ» 58,0 Β± 8,5 Π³ΠΎΠ΄Π°, ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΊΠΎΠ»Π΅Π±Π°Π»ΡΡ ΠΎΡ 1,2 Π΄ΠΎ 5,2 ΡΠΌ. ΠΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΠΎΠΉ ΡΠ°Π½Π΅Π΅ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ Π±ΡΠ»ΠΈ ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Ρ 7 Π±ΠΎΠ»ΡΠ½ΡΡ
. ΠΠΎ Π²ΡΠ΅Ρ
ΡΠ»ΡΡΠ°ΡΡ
ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ°ΡΠΏΠΎΠ»Π°Π³Π°Π»ΠΎΡΡ Π²Π½Π΅ Π·ΠΎΠ½Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΡΠ΅Π·Π΅ΠΊΡΠΈΠΈ. ΠΡΠ΅ΠΌΡ ΠΌΠ΅ΠΆΠ΄Ρ 1-ΠΉ ΠΈ 2-ΠΉ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡΠΌΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 24 (12-46) ΠΌΠ΅Ρ. ΠΡΠΈ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ Ρ 4 Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΈΠ·Π½Π°ΡΠ°Π»ΡΠ½ΠΎ Π±ΡΠ» Π²ΡΡΠ²Π»Π΅Π½ ΠΏΠΎΡΠ΅ΡΠ½ΠΎ-ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠΉ, Ρ 2 - ΠΏΠ°ΠΏΠΈΠ»Π»ΡΡΠ½ΡΠΉ, Ρ 1 - Ρ
ΡΠΎΠΌΠΎΡΠΎΠ±Π½ΡΠΉ ΡΠ°ΠΊ ΠΏΠΎΡΠΊΠΈ. Π£ 5 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ ΠΎΠ΄Π½ΠΎ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠ΅ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅, Ρ 2 - Π΄Π²Π°. ΠΠ΅ΡΠ΅ΠΆΠ°ΡΠΈΠ΅ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΎΡΡ Ρ 2, Π΅Π΅ Π²Π΅ΡΠ²ΠΈ - Ρ 3, Π±Π΅Π·ΡΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ - Ρ 2 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΎΡΠ΅Π½ΠΊΡ ΡΡΠ΅Π΄Π½Π΅ΠΉ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ, ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ, Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΡΠ΅ΠΏΠ»ΠΎΠ²ΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ, ΠΏΡΠ΅Π΄- ΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠΎΡΠ΅ΠΊ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΡΠ΅Π΄Π½Π΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΏΡΠΈ ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΉ ΠΏΠ°ΡΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 180 (130-210) ΠΌΠΈΠ½. ΠΡΠ΅ΠΌΡ ΡΠ΅ΠΏΠ»ΠΎΠ²ΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ ΠΏΡΠΈ ΠΏΠ΅ΡΠ΅ΠΆΠ°ΡΠΈΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 16 ΠΈ 20 ΠΌΠΈΠ½, ΠΏΡΠΈ ΡΠ΅Π»Π΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ ΠΈΡΠ΅ΠΌΠΈΠΈ - 14, 18 ΠΈ 24 ΠΌΠΈΠ½. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ ΠΎΠ±ΡΠ΅ΠΌ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ - 220 (80-650) ΠΌΠ». ΠΠ½ΡΡΠ°ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π½Π΅ Π·Π°ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΎ, ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ I-II ΡΡΠ΅ΠΏΠ΅Π½Π΅ΠΉ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Clavien Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ Ρ 2 Π±ΠΎΠ»ΡΠ½ΡΡ
. Π‘ΠΊΠΎΡΠΎΡΡΡ ΠΊΠ»ΡΠ±ΠΎΡΠΊΠΎΠ²ΠΎΠΉ ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ ΡΠ½ΠΈΠ·ΠΈΠ»Π°ΡΡ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π½Π° 8 % (Ρ 62 Π΄ΠΎ 54 ΠΌΠ»/ΠΌΠΈΠ½/1,73 ΠΌ2). ΠΠ° ΠΏΠ΅ΡΠΈΠΎΠ΄ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ 16 ΠΌΠ΅Ρ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π° ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π ΠΎΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π΄ΠΎΡΡΡΠΏ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ Π²ΡΠΏΠΎΠ»Π½ΠΈΡΡ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²Π½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΡΠΊΠΈ Ρ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΡΠΌΠΈ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌΠΈ ΠΈ ΠΏΡΠΎΠΌΠ΅ΠΆΡΡΠΎΡΠ½ΡΠΌΠΈ ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌΠΈ
The three-dimensional reconstruction of the dilated renal pelvicalyceal system by non-enhanced computed tomography
Introduction. The three-dimensional reconstruction of the renal pelvicalyceal system (PCS) is possible when performing enhanced computed tomography (CT). However, the use of a contrast agent has its limitations associated with the presence of allergy and chronic kidney disease.Purpose of the study. To describe the method of semi-autonomous three-dimensional (3D) reconstruction of the PCS based on non-enhanced CT images of patients with upper urinary tract obstruction.Materials and methods. Five patients diagnosed with renal colic were recruited from April-May 2021. All patients underwent CT-urography after informed consent. Medical Imaging Interaction Toolkit program (MITK) expanded with explainable update were used for 3D-reconstruction of PCS via excretory and native phases. To assess the accuracy of the latter, both contrast and non-contrast models were compared regarding their surface area. Also, the PCS of one patient was used to reconstruct virtual endoscopic views based on enhanced and non-enhanced models. Five urologists estimated their similarity and potential use of non-enhanced models for the interventional planning via a Likert scale questionnaire. The resulting models were also analyzed by programmer-engineers to test their suitability for 3D-printing.Results. The average surface area of enhanced and non-enhanced models was 3291 mm2 and 2879 mm2, respectively. Obtained models were suitable for their intraluminal reconstruction and potential 3D-printing. Analyzed properties of non-enhanced models were estimated at 4.5 out of 5.0.Conclusion. The described semi-autonomous reconstruction of the renal PCS based on non-enhanced CT images allows for a short time to reconstruct its 3D-view in patients with the upper urinary tract obstruction
Nephrostomy tube misplacement in the inferior vena cava following percutaneous nephrostomy
Percutaneous renal interventions are characterized by bleeding and infectious complications, as well as trauma to organs located near the kidney, renal or inferior vena cava (IVC). The article presents a clinical observation of a rare complication of percutaneous nephrostomy (PCN), i.e. migration of the distal end of the nephrostomy tube into the IVC. Its timely removal followed by re-nephrostomy made it possible to avoid bleeding and restore drainage of the pyelocalyceal system. Along with this, the article presents a literature review on this condition in the eLibrary, Springer, MedLine, Embase, UpToDate databases from 2000 to 2021. The indications for PCN, the frequency and risk factors of IVC damage during percutaneous renal interventions, as well as treatment tactics were studied. After the initial evaluation of the literature, ten articles were selected for further analysis. The main risk factors associated with IVC perforation after PCN include the surgeon's lack of experience in instrumental imaging, misjudgment of the length of the nephrostomy tube, and its insertion depth, resulting in its inadequate placement. Removal of the nephrostomy tube from the IVC under radiological and ultrasound guidance or open surgery are the main methods to correct for this complication
Retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula
Introduction. Calyceal fistula is a rare complication of a renal transplantation. This complication can lead to postoperative graft failure. The treatment approaches range from a partial nephrectomy to a routine nephrostomy.Objective. To present the successful application of the retrograde endoscopic-assisted percutaneous treatment of transplanted kidney calyceal fistula.Clinical case. A patient after kidney allotransplantation is under our care. Control postoperative ultrasound examination revealed a pararenal fluid mass in the left iliac region. Its percutaneous drainage was performed. Biochemical analysis revealed high levels of creatinine and urea in the drainage discharge. Despite ureteral stent and urethral catheter drainage, about 500 to 600 ml of urine per day was excreted by the drainage. Percutaneous puncture nephrostomy could not be performed due to the absence of dilatation of the renal cavity system. In the lithotomic position, the damaged calyx was identified by performing flexible ureteropyeloscopy. Then we percutaneously targeted the injured calyx and the distal end of the ureteroscope inserted transurethrally, so that the needle tip appeared in the paranephral cavity opposite the injured calyx. Under the control of a flexible ureteroscope the needle was inserted into the kidney pelvis, a nephrostomy tube 12 Ch was placed along the string. The discharge through the drain stopped within a week and it was removed. Follow-up examination nine weeks after surgery revealed that the patient had no complaints and renal ultrasound showed no features, so the nephrostomy tube was removed.Conclusion. The described method is the minimally invasive, affordable, and efficient method for the treatment of transplanted kidney calyceal fistula
Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture
A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain
- β¦