Варианты оценки почечной функции после органосохраняющих операций у пациентов с почечно-клеточным раком

Abstract

Introduction. Despite the improvement of various methods of surgical and ablative methods of treating kidney cancer, the question remains about the functional state of the kidney after surgical treatment. Along with the achievement of oncological results, the preservation of renal function is the main task in the treatment of tumorous diseases of the kidneys. Aim. To evaluate the functional results of organ-preserving operations with a preventive suture with preserved blood flow, as well as in patients who underwent a resection of the kidney with compression of the renal pedicle, using nephroscintigraphy. Material and Methods. The study included 175 patients in stages pT1a-T2bN0M0, which are divided into 2 groups. Group 1 – 150 patients who underwent organ-preserving options with the use of preventive hemostatic sutures, allowing operations to be performed without clamping the kidney leg. 25 patients underwent a resection of the kidney with compression of the renal pedicle. To assess renal function, patients underwent dynamic nephroscintigraphy. In the first group, the tumor was located in the central segment in 64 patients, in the upper segment in 45 patients, in the lower segment in 41 patients. Stage T1a was established in 74 patients, stage T1b in 53 patients, stage T2a in 4 patients. In 19 patients diagnosed with cystic T1a cancers. In the second group in the central segment – in 10 patients, in the upper segment in 7 patients and in 8 patients in the lower. According to the stages, patients were divided as follows – T1a – 16, T1b – 8, T2a – 1. Results. Organ-preserving operations were performed for all patients. In the first group, in no case did the renal pedicle be pinched. The average time of thermal ischemia in the second group was 13 ± 2 min. The perfusion and renal index for the operated kidney in both groups was comparable, and amounted to 54.13 ± 2% and 53.24 ± 4%. However, after surgical treatment, the indicators were significantly different. In the first group, the perfusion index was 46.82 ± 2.39% against 35 ± 1.52% in the second, the renal index in the first group was 46.82 ± 2.39%, against 39 ± 0.88% in the second. Conclusion. Thus, even short-term thermal ischemia leads to significant impairment of renal function. Preventive suture allows you to remove a tumor from any part of the kidney, while maintaining blood flow, and allows you to protect the renal parenchyma from ischemic damage.