161 research outputs found
The Value of Legal Terminology for the Romano-German Legal System Countries
The problems of terminology are relevant for any aspect of human life. In the field of lawmaking, the significance of this problem corresponds to the significance of laws in society. Thus, the primary aim of the article is to investigate the place of legal terminology in the countries of the continental system of law. To accomplish end, this survey attempts to substantiate that legal terminology in this legal system is of significant importance for the formation and application of legislation. To do so, a comparison is made with the construction of the legal system in the countries of the Anglo-Saxon legal system. Based on the result, Russian law is classified as a continental legal family. At the same time, based on an analysis of the key areas of development of economic legislation, a tendency has been revealed for the penetration of Anglo-Saxon legal institutions into the Russian legal system. The conclusion is formulated on the need to ensure the unity of legal terminology in legal texts. This is of particular importance when borrowing foreign legal institution
Novel self-assembling system based on resorcinarene and cationic surfactant
Mixed association of calix[4]resorcinarene with ethyl sulfonate groups on the lower rim and dimethylaminomethyl groups on the upper rim (CR) and cationic surfactant 4-aza-1-hexadecyl-azoniabicyclo[2.2.2]octane bromide (DABCO-16) is studied by methods of tensiometry, conductometry, potentiometry and NMR spectroscopy at fixed CR concentration and varied surfactant concentration. Beyond ca. 0.4 mM of DABCO-16, mixed aggregates enriched by CR are proved to be formed due to electrostatic forces, while beyond ca. 5 mM, aggregates enriched by surfactant occur due to the hydrophobic effect. Spectrophotometry monitoring of the solubilization of a hydrophobic dye, Orange OT, demonstrated that only the second type of mixed aggregate enriched by DABCO-16 is capable of binding the organic probe, while the mixed system where the surfactant is a minor component shows no binding capacity towards Orange OT. This finding can be used for the design of nanocontainers with controllable binding/release properties.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-gefΓΆrderten) Allianz- bzw. Nationallizenz frei zugΓ€nglich
Numerical Study of the Working Space of the Furnace of a Methodical Pusher Furnace with a Production Furnace of 10 Tons/Hour
Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠ΅ΠΏΠ»ΠΎΠ²ΠΎΠ³ΠΎ ΡΠ°ΡΡΠ΅ΡΠ° ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΡΡΡ Π²Π½ΡΡΡΠΈ ΡΠ°Π±ΠΎΡΠ΅Π³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π° ΡΠΎΠΏΠΊΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΎΠ»ΠΊΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΠΈ. Π Π°ΡΡΠΌΠΎΡΡΠ΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΠΈΡΡ Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½Ρ Π½Π° ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΏΡΠΎΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅ΠΏΠ»ΠΎΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΡΠ°Π½ΠΎΠ²ΠΎΠΊ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΠΊΠΎΠΌΠΏΡΡΡΠ΅ΡΠ½ΡΡ
ΡΠ°ΡΡΠ΅ΡΠΎΠ². CFD-ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π·Π°Π΄Π°ΡΠΈ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ Π² ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎΠΌ ΠΏΡΠΎΠ΄ΡΠΊΡΠ΅ Ansys Fluent.The work analyzes the results of the thermal calculation of the distribution inside the working space of the furnace of the methodical pusher furnace. The considered theses are aimed at studying the methods of designing heat engineering installations using computer calculations. CFD modeling was carried out in the Ansys Fluent software product
Investigation of Combustion Fuel in a Ring Metallurgical Furnace Using CFD Modeling
Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠΈΡΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π³ΠΎΡΠ΅Π½ΠΈΡ ΡΠΎΠΏΠ»ΠΈΠ²Π° Π² ΡΠ°Π±ΠΎΡΠ΅ΠΉ ΠΊΠ°ΠΌΠ΅ΡΠ΅ ΠΊΠΎΠ»ΡΡΠ΅Π²ΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ΅ΡΠΈ. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΎ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΏΡΠΎΠ΄ΡΠΊΡΠΎΠ² ΡΠ³ΠΎΡΠ°Π½ΠΈΡ ΠΏΠΎ ΡΠ°Π±ΠΎΡΠ΅ΠΉ ΠΊΠ°ΠΌΠ΅ΡΠ΅. CFD-ΠΌΠΎΠ΄Π΅Π»ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π³ΠΎΡΠ΅Π½ΠΈΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ Π² ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎΠΌ ΠΏΡΠΎΠ΄ΡΠΊΡΠ΅ Ansys Fluent.This paper presents a study of numerical simulation of fuel combustion in the working chamber of the ring methodical furnace. The distribution of combustion products in the working chamber is determined. CFD modeling of combustion research is performed in the Ansys Fluent software product
Π‘Π»ΡΡΠ°ΠΉ Ρ ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π³ΠΈΠ³Π°Π½ΡΡΠΊΠΎΠΉ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠΏΡΡ ΠΎΠ»ΠΈ ΠΏΠΎΡΠΊΠΈ
Renal tumors account for 2 to 3 % of all malignant tumors in adults. Of all patients with renal cell carcinoma, 30 to 40 % have advanced forms of the disease. In the literature, the term "giant renal tumor" is used for tumors larger than 20 cm. In this article, we report a case of surgical treatment for a giant malignant kidney tumor.Patient N., female, 54 years old, referred to an outpatient clinic with complaints of a change in the shape of the abdomen on the left with a palpable large tumor, abdominal pain, shortness of breath, weakness, constipation, episodes of blood in the urine and increased blood pressure. Body mass index 30.2 kg/m2. Ultrasound examination revealed a large tumor in the left retroperitoneal space. Laboratory testing of blood, urine was performed, findings were unremarkable. According to the data of magnetic resonance imaging, the left kidney was transformed into a large cystic solid formation, measuring 30.5 Ρ
17.5 Ρ
17.0 cm, heterogeneously accumulating a contrast agent with a solid component. Patient was admitted to the urology department for surgical treatment. We performed radical nephrectomy on the left with thoracolumbar laparotomy access on the left with resection of the 10th rib, resecting the renal tumor with the adrenal gland, total weight of the complex was 10.7 kg. The histological structure was determined as poorly differentiated renal carcinoma with invasion of the perinephric tissue. In the adrenal gland, fields of fresh erythrocytes with an admixture of tumor tissue were noted. Examined lymph node tissue was completely replaced by tumor cells. Postoperative period was characterized by episodes of dynamic intestinal obstruction. The patient was discharged from the department in a satisfactory condition on the 13th day after the operation, but died 1.5 months after discharge, the cause of death has not been established, as no autopsy was performed. Thus, the size of the tumor is not a contraindication to surgical treatment, which improves the survival rate of patients with malignant renal tumors.ΠΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΡΠ΅ΠΊ ΡΠΎΡΡΠ°Π²Π»ΡΡΡ 2-3 % Π²ΡΠ΅Ρ
Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΎΠΏΡΡ
ΠΎΠ»Π΅ΠΉ Π²Π·ΡΠΎΡΠ»ΡΡ
. Π‘ΡΠ΅Π΄ΠΈ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΏΠΎΡΠ΅ΡΠ½ΠΎ-ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠΌ ΡΠ°ΠΊΠΎΠΌ 30-40 % ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅ΡΡ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΡΠ΅ ΡΠΎΡΠΌΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. Π Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅ Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ ΡΠ΅ΡΠΌΠΈΠ½ Β«Π³ΠΈΠ³Π°Π½ΡΡΠΊΠ°Ρ ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΠΏΠΎΡΠΊΠΈΒ». ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΡΠ°Π·ΠΌΠ΅ΡΠΎΠΌ >20 ΡΠΌ ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΏΡΠΈΠ·Π½Π°Π½Π° ΠΊΠ°ΠΊ Π³ΠΈΠ³Π°Π½ΡΡΠΊΠ°Ρ. Π Π½Π°ΡΡΠΎΡΡΠ΅ΠΉ ΡΡΠ°ΡΡΠ΅ ΠΎΠΏΠΈΡΠ°Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π³ΠΈΠ³Π°Π½ΡΡΠΊΠΎΠΉ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΡΠΊΠΈ.ΠΠ°ΡΠΈΠ΅Π½ΡΠΊΠ° Π., 54 Π»Π΅Ρ, ΠΎΠ±ΡΠ°ΡΠΈΠ»Π°ΡΡ Ρ ΠΆΠ°Π»ΠΎΠ±Π°ΠΌΠΈ Π½Π° ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠΎΡΠΌΡ ΠΆΠΈΠ²ΠΎΡΠ° ΡΠ»Π΅Π²Π°, Π±ΠΎΠ»ΠΈ Π² ΠΆΠΈΠ²ΠΎΡΠ΅, ΠΎΠ΄ΡΡΠΊΡ, ΡΠ»Π°Π±ΠΎΡΡΡ, Π·Π°ΠΏΠΎΡΡ, ΡΠΏΠΈΠ·ΠΎΠ΄Ρ ΠΊΡΠΎΠ²ΠΈ Π² ΠΌΠΎΡΠ΅, ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ. ΠΠ½Π΄Π΅ΠΊΡ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ 30,2 ΠΊΠ³/ΠΌ2. ΠΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π±ΡΠ»Π° Π²ΡΡΠ²Π»Π΅Π½Π° Π±ΠΎΠ»ΡΡΠ°Ρ ΠΎΠΏΡΡ
ΠΎΠ»Ρ Π² Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠΌ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅ ΡΠ»Π΅Π²Π°. Π Π°Π½Π°Π»ΠΈΠ·Π°Ρ
ΠΊΡΠΎΠ²ΠΈ ΠΈ ΠΌΠΎΡΠΈ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π½Π΅ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½ΠΎ. ΠΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ Π»Π΅Π²Π°Ρ ΠΏΠΎΡΠΊΠ° ΡΡΠ°Π½ΡΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π° Π² ΠΊΡΡΠΏΠ½ΠΎΠ΅ ΠΊΠΈΡΡΠΎΠ·Π½ΠΎ-ΡΠΎΠ»ΠΈΠ΄Π½ΠΎΠ΅ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ°Π·ΠΌΠ΅ΡΠΎΠΌ 30,5 Ρ
17,5 Ρ
17,0 ΡΠΌ, Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎ Π½Π°ΠΊΠ°ΠΏΠ»ΠΈΠ²Π°ΡΡΠ΅Π΅ ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½ΡΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ ΡΠΎΠ»ΠΈΠ΄Π½ΡΠΌ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠΌ. ΠΠ°ΡΠΈΠ΅Π½ΡΠΊΠ΅ Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ ΡΠ»Π΅Π²Π° ΡΠΎΡΠ°ΠΊΠΎΠ»ΡΠΌΠ±ΠΎΠ»Π°ΠΏΠ°ΡΠΎΡΠΎΠΌΠ½ΡΠΌ Π΄ΠΎΡΡΡΠΏΠΎΠΌ Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΠ΅ΠΉ X ΡΠ΅Π±ΡΠ°. Π£Π΄Π°Π»Π΅Π½Π° ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΠΏΠΎΡΠΊΠΈ Ρ Π½Π°Π΄ΠΏΠΎΡΠ΅ΡΠ½ΠΈΠΊΠΎΠΌ, ΡΡΠΌΠΌΠ°ΡΠ½Π°Ρ ΠΌΠ°ΡΡΠ° ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 10,7 ΠΊΠ³. Π Π΅Π·ΡΠ»ΡΡΠ°Ρ Π³ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: Π½ΠΈΠ·ΠΊΠΎΠ΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΊΠ°ΡΡΠΈΠ½ΠΎΠΌΠ° ΠΏΠΎΡΠΊΠΈ Ρ ΠΈΠ½Π²Π°Π·ΠΈΠ΅ΠΉ Π² ΠΏΠ°ΡΠ°Π½Π΅ΡΡΠ°Π»ΡΠ½ΡΡ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΡ. Π Π½Π°Π΄ΠΏΠΎΡΠ΅ΡΠ½ΠΈΠΊΠ΅ ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΈΡΡ ΠΏΠΎΠ»Ρ ΡΠ²Π΅ΠΆΠΈΡ
ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ² Ρ ΠΏΡΠΈΠΌΠ΅ΡΡΡ ΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΠΎΠΌ Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠ·Π»Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ΅ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²ΠΎΠΉ ΡΠΊΠ°Π½ΡΡ (ΡΠ·Π΅Π» ΡΠ°Π·ΠΌΠ΅ΡΠΎΠΌ 5 Ρ
5 ΡΠΌ). Π ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ ΡΠΏΠΈΠ·ΠΎΠ΄Ρ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΈΡΠ΅ΡΠ½ΠΎΠΉ Π½Π΅ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΠΈ. ΠΠΎΠ»ΡΠ½Π°Ρ Π±ΡΠ»Π° Π²ΡΠΏΠΈΡΠ°Π½Π° Π² ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌ ΡΠΎΡΡΠΎΡΠ½ΠΈΠΈ Π½Π° 13-Π΅ ΡΡΡΠΊΠΈ ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ. Π§Π΅ΡΠ΅Π· 1,5 ΠΌΠ΅Ρ ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΈΡΠΊΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ° ΡΠΌΠ΅ΡΠ»Π°. ΠΡΠΈΡΠΈΠ½Π° Π²Π½Π΅Π·Π°ΠΏΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠΈ Π½Π΅ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π°, ΡΠ°ΠΊ ΠΊΠ°ΠΊ Π²ΡΠΊΡΡΡΠΈΠ΅ Π½Π΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΎΡΡ. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π½Π΅ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠ΅ΠΌ ΠΊ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΡΡΠΎ ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π΅Ρ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠΊΠΈ
Π Π΅ΡΠΈΠ΄ΠΈΠ² ΠΊΠΎΠΌΠΏΠΎΠ·ΠΈΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠ°Π½Π³ΠΈΠΎΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠΎΠΌΡ ΠΏΠΎΡΠΊΠΈ: ΡΠ»ΡΡΠ°ΠΉ ΠΈΠ· ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ
Composite hemangioendothelioma is an extremely rare form of kidney tumor. The tumor mainly occurs in the extremities, head and neck; internal organs involvement is rarely reported. Patient, 61-year-old male, was admitted to the urology department for a left kidney tumor, which was found accidentally during an ultrasound examination. Magnetic resonance imaging showed an irregularly shaped tumor measuring 5.0 Γ 6.0 Γ 4.0 cm and located in the lower pole of the left kidney. The tumor was surgically removed with resection of the capsule of the kidney lower pole. Immunohistochemical study revealed diffuse bright expression of CD31 (clone JC70A), CD34 (clone QBEnd 10), ERG (clone ER111), FLI-1 (clone MRQ-1) in tumor cells. The index of proliferative activity Ki-67 (clone SP6) was 40 %. The morphological picture and immunophenotype of the tumor correspond to composite hemangioendothelioma of the retroperitoneal space. Magnetic resonance imaging of the retroperitoneal space on follow-up visit in 9 months visualized a tumor of the left kidney measuring 8.3 Γ 8.4 Γ 7.8 cm. Radical nephrectomy was performed. Pathology examination showed that tumor tissue was mainly represented by solid fields of the spindle cell component. In samples of the border between the tumor and fatty pararenal tissue, tumor invasion was observed up to the adjacent striated muscles, tumor growth into the tissue of the kidney gate was also found. Taking into account the morphological picture and the earlier immunohistochemical study, the removed tumor corresponds to composite hemangioendothelioma.Composite hemangioendothelioma is a tumor of low malignant potential. It is extremely rare for this tumor to affect the kidney. At the same time, in the described case, the tumor was initially located in the retroperitoneal space, with involvement of the kidney capsule, and was assessed as a benign lesion. After 9 months, there was a recurrence of the tumor localized in the kidney with damage to the elements of the renal sinus, retroperitoneal tissue, and lumbar muscles. In this case, the tumor has significant malignant potential.ΠΠΎΠΌΠΏΠΎΠ·ΠΈΡΠ½Π°Ρ Π³Π΅ΠΌΠ°Π½Π³ΠΈΠΎΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠΎΠΌΠ° β ΠΎΠ΄Π½Π° ΠΈΠ· ΠΊΡΠ°ΠΉΠ½Π΅ ΡΠ΅Π΄ΠΊΠΈΡ
ΡΠΎΡΠΌ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΡΠΊΠΈ. ΠΠΏΡΡ
ΠΎΠ»Ρ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΡΠ΅ΡΡΡ Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΌ Π² ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΡΡ
, Π³ΠΎΠ»ΠΎΠ²Π΅ ΠΈ ΡΠ΅Π΅, ΡΠ΅Π΄ΠΊΠΎ ΡΠΎΠΎΠ±ΡΠ°Π΅ΡΡΡ ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠΈ Π²Π½ΡΡΡΠ΅Π½Π½ΠΈΡ
ΠΎΡΠ³Π°Π½ΠΎΠ². ΠΠΎΠ»ΡΠ½ΠΎΠΉ 61 Π³ΠΎΠ΄Π° ΠΎΠ±ΡΠ°ΡΠΈΠ»ΡΡ Π² ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π² Π»Π΅Π²ΠΎΠΉ ΠΏΠΎΡΠΊΠ΅, ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π½ΠΎΠΉ ΡΠ»ΡΡΠ°ΠΉΠ½ΠΎ ΠΏΡΠΈ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ. ΠΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ Π² ΠΎΠ±Π»Π°ΡΡΠΈ Π½ΠΈΠΆΠ½Π΅Π³ΠΎ ΠΏΠΎΠ»ΡΡΠ° Π»Π΅Π²ΠΎΠΉ ΠΏΠΎΡΠΊΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»Π°ΡΡ Π½Π΅ΠΏΡΠ°Π²ΠΈΠ»ΡΠ½ΠΎΠΉ ΡΠΎΡΠΌΡ ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΡΠ°Π·ΠΌΠ΅ΡΠΎΠΌ 5,0 Γ 6,0 Γ 4,0 ΡΠΌ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅, ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΡΠ΄Π°Π»Π΅Π½Π° Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΠ΅ΠΉ ΠΊΠ°ΠΏΡΡΠ»Ρ Π½ΠΈΠΆΠ½Π΅Π³ΠΎ ΠΏΠΎΠ»ΡΡΠ° ΠΏΠΎΡΠΊΠΈ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ ΠΈΠΌΠΌΡΠ½ΠΎΠ³ΠΈΡΡΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: Π² ΠΊΠ»Π΅ΡΠΊΠ°Ρ
ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ β Π΄ΠΈΡΡΡΠ·Π½Π°Ρ ΡΡΠΊΠ°Ρ ΡΠΊΡΠΏΡΠ΅ΡΡΠΈΡ CD31 (ΠΊΠ»ΠΎΠ½ JC70A), CD34 (ΠΊΠ»ΠΎΠ½ QBEnd 10), ERG (ΠΊΠ»ΠΎΠ½ ER111), FLI-1 (ΠΊΠ»ΠΎΠ½ MRQ-1). ΠΠ½Π΄Π΅ΠΊΡ ΠΏΡΠΎΠ»ΠΈΡΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Ki-67 (ΠΊΠ»ΠΎΠ½ SP6) 40 %. ΠΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΊΠ°ΡΡΠΈΠ½Π° ΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅Π½ΠΎΡΠΈΠΏ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡ ΠΊΠΎΠΌΠΏΠΎΠ·ΠΈΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠ°Π½Π³ΠΈΠΎΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠΎΠΌΠ΅ Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π°. ΠΡΠΈ ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎ-ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½ΠΎΠΉ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΠΈ Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π° ΡΠ΅ΡΠ΅Π· 9 ΠΌΠ΅Ρ Π²ΡΡΠ²Π»Π΅Π½Π° ΠΎΠΏΡΡ
ΠΎΠ»Ρ Π»Π΅Π²ΠΎΠΉ ΠΏΠΎΡΠΊΠΈ ΡΠ°Π·ΠΌΠ΅ΡΠΎΠΌ 8,3 Γ 8,4 Γ 7,8 ΡΠΌ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΠΎΠ±ΡΠ΅ΠΌΠ΅ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠΈ. ΠΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: ΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²Π°Ρ ΡΠΊΠ°Π½Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π° ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΡΠΎΠ»ΠΈΠ΄Π½ΡΠΌΠΈ ΠΏΠΎΠ»ΡΠΌΠΈ ΠΏΠΎ ΡΠΈΠΏΡ Β«Π²Π΅ΡΠ΅ΡΠ΅Π½ΠΎΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠ³ΠΎΒ» ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠ°. Π ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°Ρ
, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π½ΡΡ
Π³ΡΠ°Π½ΠΈΡΠ΅ΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΈ ΠΆΠΈΡΠΎΠ²ΠΎΠΉ ΠΏΠ°ΡΠ°Π½Π΅ΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ, ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΡΡΡ ΠΈΠ½Π²Π°Π·ΠΈΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π²ΠΏΠ»ΠΎΡΡ Π΄ΠΎ ΠΏΡΠΈΠ»Π΅ΠΆΠ°ΡΠ΅ΠΉ ΠΏΠΎΠΏΠ΅ΡΠ΅ΡΠ½ΠΎ-ΠΏΠΎΠ»ΠΎΡΠ°ΡΠΎΠΉ ΠΌΡΡΠΊΡΠ»Π°ΡΡΡΡ, ΡΠ°ΠΊΠΆΠ΅ Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ ΡΠΎΡΡ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Π² ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΡ Π²ΠΎΡΠΎΡ ΠΏΠΎΡΠΊΠΈ. Π‘ ΡΡΠ΅ΡΠΎΠΌ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Ρ ΠΈ Π΄Π°Π½Π½ΡΡ
ΠΈΠΌΠΌΡΠ½ΠΎΠ³ΠΈΡΡΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠ΄Π°Π»Π΅Π½Π½Π°Ρ ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΠ΅Ρ ΠΊΠΎΠΌΠΏΠΎΠ·ΠΈΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠ°Π½Π³ΠΈΠΎΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠΎΠΌΠ΅.ΠΠΎΠΌΠΏΠΎΠ·ΠΈΡΠ½Π°Ρ Π³Π΅ΠΌΠ°Π½Π³ΠΈΠΎΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠΎΠΌΠ° β ΠΎΠΏΡΡ
ΠΎΠ»Ρ Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΌ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΠΎΠΌ. ΠΡΠ°ΠΉΠ½Π΅ ΡΠ΅Π΄ΠΊΠΎ Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ ΠΏΠΎΡΠΊΠΈ. Π ΠΎΠΏΠΈΡΠ°Π½Π½ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΠΏΠ΅ΡΠ²ΠΎΠ½Π°ΡΠ°Π»ΡΠ½ΠΎ ΠΎΠΏΡΡ
ΠΎΠ»Ρ Π»ΠΎΠΊΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π»Π°ΡΡ Π² Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠΌ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π΅ Ρ Π²ΠΎΠ²Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΊΠ°ΠΏΡΡΠ»Ρ ΠΏΠΎΡΠΊΠΈ ΠΈ ΠΎΡΠ΅Π½Π΅Π½Π° ΠΊΠ°ΠΊ Π΄ΠΎΠ±ΡΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ΅ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅. Π§Π΅ΡΠ΅Π· 9 ΠΌΠ΅Ρ ΠΎΡΠΌΠ΅ΡΠ΅Π½ ΡΠ΅ΡΠΈΠ΄ΠΈΠ² ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Ρ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠ΅ΠΉ Π² ΠΏΠΎΡΠΊΠ΅ Ρ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ»Π΅ΠΌΠ΅Π½ΡΠΎΠ² ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ½ΡΡΠ°, ΠΊΠ»Π΅ΡΡΠ°ΡΠΊΠΈ Π·Π°Π±ΡΡΡΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΡΡΠ°Π½ΡΡΠ²Π° ΠΈ ΠΏΠΎΡΡΠ½ΠΈΡΠ½ΡΡ
ΠΌΡΡΡ. Π Π΄Π°Π½Π½ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΠΈΠΌΠ΅Π΅Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΉ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ Ρ ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ ΠΎΠΏΡΡ ΠΎΠ»Π΅ΠΉ ΠΏΠΎΡΠΊΠΈ ΠΏΠΎ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Π°ΠΌ ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊ Π‘ΠΈΠ±ΠΠΠ£
Aim. To analyze the results of treatment of patients with kidney tumors in urology departments of the Siberian State Medical University clinics.Materials and methods. The number of patients with kidney tumors hospitalized in the urology department of the general surgery clinic was 7β10 % of the total annual number of surgical interventions in the urology department. We analyzed 132 cases of malignant kidney tumors. All patients went through imaging and laboratory studies.Results. Treatment results are known in 125 (94.0 %) patients. Mean age of patients was 57.9 years (27 to 86), there were 77 men and 55 women (1.4:1 ratio). Mean tumor size was 6.5 Β± 3.6 cm, no significant differences were observed between men and women. Radical nephrectomy was performed in 75 (56.8 %) patients, kidney resection in 57 (43.2 %) patients. Tumor size in nephrectomy cases was 8.2 Β± 3.7 cm and 4.3 Β± 2.1 cm in kidney resection (p <0.05). In patients with larger tumors five-year survival was lower: tumor size Β£4 cm was associated with five-year survival of 79.6 %, while tumor size >7 cm with only 36.9 % (p = 0.001).In our study, 23 (17.4 %) patients with inferior vena cava thrombosis were operated on: 11 (8.3 %) men, 12 (9.1 %) women. Mean age of patients with inferior vena cava thrombosis was 57.2 years (between 35 and 74 years). In this group of patients, mean tumor size was 10.8 Β± 4.1 cm (between 4.2 and 19). Based on TNM classification, tumors were classified as follows: T3b stage β 17 (12.9 %), T4 stage β 6 (4.5 %), N0 β 15 (11.4 %), N+ β 8 (6.1 %). Left kidney was affected in 6 (4.5 %) cases, right kidney was affected in 17 (12.9 %) cases. Type of surgery performed in this group of patients was classified as: radical nephrectomy with thrombectomy and lymphadenectomy, one case included resection of the inferior vena cava with a section reconstructed using a xenopericardial transplant. Mean surgery duration was 212.4 Β± 52.3 (130β320) minutes. Mean blood loss volume was 1177.0 Β± 933.4 (100β4600) ml. Postoperative complications were observed in 35 (21.2 %) patients. Overall five-year survival for patients with malignant kidney tumors was 61.8 %, for patients with tumor thrombosis it was 31.3 %.Conclusion. Surgical treatment of patients with malignant kidney tumors allows to significantly improve patientsβ survival preserving quality of life.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β Π°Π½Π°Π»ΠΈΠ· ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠΊΠΈ Π² ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊ Π‘ΠΈΠ±ΠΈΡΡΠΊΠΎΠ³ΠΎ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠ³ΠΎ ΡΠ½ΠΈΠ²Π΅ΡΡΠΈΡΠ΅ΡΠ°.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠΎΠ»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ ΠΎΠΏΡΡ
ΠΎΠ»ΡΠΌΠΈ ΠΏΠΎΡΠΊΠΈ, Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΈ Π‘ΠΈΠ±ΠΈΡΡΠΊΠΎΠ³ΠΎ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠ³ΠΎ ΡΠ½ΠΈΠ²Π΅ΡΡΠΈΡΠ΅ΡΠ°, ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ Π΄ΠΎ 7β10 % ΠΎΠ±ΡΠ΅Π³ΠΎ ΡΠΈΡΠ»Π° ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ Π΅ΠΆΠ΅Π³ΠΎΠ΄Π½ΠΎ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ 132 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ ΠΏΠΎΡΠΊΠΈ. ΠΡΠ΅ΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ Π² Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Ρ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΈ Π²ΠΈΠ·ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π Π΅Π·ΡΠ»ΡΡΠ°Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΈΠ·Π²Π΅ΡΡΠ΅Π½ Ρ 125 (94,0 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎΡΡΠ°Π²ΠΈΠ» 57,9 (27β86) Π³ΠΎΠ΄Π°. ΠΡΠΆΡΠΈΠ½ Π±ΡΠ»ΠΎ 77, ΠΆΠ΅Π½ΡΠΈΠ½ β 55, ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ β 1,4:1. Π‘ΡΠ΅Π΄Π½ΠΈΠΉ ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 6,5 Β± 3,6 ΡΠΌ, ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Ρ ΠΌΡΠΆΡΠΈΠ½ ΠΈ ΠΆΠ΅Π½ΡΠΈΠ½ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ Π½Π΅ ΡΠ°Π·Π»ΠΈΡΠ°Π»ΡΡ. Π Π°Π΄ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° 75 (56,8 %) ΠΈ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ ΠΏΠΎΡΠΊΠΈ 57 (43,2 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ. Π Π°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΠΎΠΉ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ ΡΠΎΡΡΠ°Π²ΠΈΠ» 8,2 Β± 3,7 ΡΠΌ, Ρ ΡΠ΅Π·Π΅ΠΊΡΠΈΠ΅ΠΉ ΠΏΠΎΡΠΊΠΈ β 4,3 Β± 2,1 ΡΠΌ (p <0,05). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π±ΠΎΠ»ΡΡΠΈΠΌ ΡΠ°Π·ΠΌΠ΅ΡΠΎΠΌ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΎΠ±ΡΠ°Ρ 5-Π»Π΅ΡΠ½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ Π½ΠΈΠΆΠ΅: ΠΏΡΠΈ ΡΠ°Π·ΠΌΠ΅ΡΠ΅ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ Β£4 ΡΠΌ β 79,6 %, ΠΏΡΠΈ ΡΠ°Π·ΠΌΠ΅ΡΠ΅ >7 ΡΠΌ β 36,9 % (p = 0,001).ΠΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΡΠΎΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Ρ ΡΡΠΎΠΌΠ±ΠΎΠΌ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΏΠΎΠ»ΠΎΠΉ Π²Π΅Π½Ρ, Π±ΡΠ»ΠΎ 23 (17,4 %), ΠΈΠ· Π½ΠΈΡ
11 (8,3 %) ΠΌΡΠΆΡΠΈΠ½, 12 (9,1 %) ΠΆΠ΅Π½ΡΠΈΠ½. ΠΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΎΠΌΠ±ΠΎΠΌ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΏΠΎΠ»ΠΎΠΉ Π²Π΅Π½Ρ ΡΠΎΡΡΠ°Π²ΠΈΠ» 57,2 (35β74) Π³ΠΎΠ΄Π°, ΡΠ°Π·ΠΌΠ΅Ρ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ ΠΏΠΎΡΠΊΠΈ β 10,8 Β± 4,1 ΡΠΌ. Π Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΡΡΠ°Π΄ΠΈΠΈ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ TNM ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ ΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ: ΡΡΠ°Π΄ΠΈΡ T3b β 17 (12,9 %) ΠΈ T4 β 6 (4,5 %), N0 β 15 (11,4 %) ΠΈ N+ β 8 (6,1 %). Π£ 17 (12,9 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½Π° ΠΎΠΏΡΡ
ΠΎΠ»Ρ ΠΏΡΠ°Π²ΠΎΠΉ ΠΏΠΎΡΠΊΠΈ, Ρ 6 (4,5 %) β ΠΎΠΏΡΡ
ΠΎΠ»Ρ Π»Π΅Π²ΠΎΠΉ ΠΏΠΎΡΠΊΠΈ. ΠΠ±ΡΠ΅ΠΌ Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π½ΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ Π² ΡΡΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²: ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ Π½Π΅ΡΡΡΠΊΡΠΎΠΌΠΈΡ Ρ ΡΡΠΎΠΌΠ±ΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ ΠΈ Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ, Π² 1 ΡΠ»ΡΡΠ°Π΅ ΡΠ΅Π·Π΅ΠΊΡΠΈΡ Π½ΠΈΠΆΠ½Π΅ΠΉ ΠΏΠΎΠ»ΠΎΠΉ Π²Π΅Π½Ρ Ρ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ° ΠΊΡΠ΅Π½ΠΎΠΏΠ΅ΡΠΈΠΊΠ°ΡΠ΄ΠΈΠ°Π»ΡΠ½ΡΠΌ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΎΠΌ. ΠΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΎΠΌΠ±ΡΠΊΡΠΎΠΌΠΈΠ΅ΠΉ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 212,4 Β± 52,3 (130β320) ΠΌΠΈΠ½. ΠΠ±ΡΠ΅ΠΌ ΠΊΡΠΎΠ²ΠΎΠΏΠΎΡΠ΅ΡΠΈ β 1177,0 Β± 933,4 (100β4600) ΠΌΠ». ΠΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΏΠΎΡΠ»Π΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°Π·Π²ΠΈΠ»ΠΈΡΡ Ρ 35 (21,2 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ±ΡΠ°Ρ 5-Π»Π΅ΡΠ½ΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ ΠΏΠΎΡΠΊΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 61,8 %, ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΠΏΡΡ
ΠΎΠ»Π΅Π²ΡΠΌ ΡΡΠΎΠΌΠ±ΠΎΠΌ β 31,3 %.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π₯ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΡΡ ΠΏΠΎΡΠΊΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΡΠ²Π΅Π»ΠΈΡΠΈΡΡ ΠΈΡ
Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ ΠΏΡΠΈ Π²ΡΡΠΎΠΊΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΆΠΈΠ·Π½ΠΈ
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