Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press63610.17650/1726-9776-2017-13-2-20-26DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиStructure of 90 day complications after solitary kidney resection due to parenchyma tumorsСтруктура 90-дневных осложнений после резекции единственной почки при опухолях ее паренхимыAtduevV. A.АтдуевВ. А.
Russian Federation

10/1 Minina and Pozharskogo Sq., Nizhniy Novgorod 603950

Вагиф Атдуев 

603950 Нижний Новгород, пл. Минина и Пожарского, 10/1

shejxoff@yandex.ruSheiykhovG. I.ШейыховГ. И.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

Шейыхов Гаджикерим Исламович

603001 Нижний Новгород, Нижневолжская набережная, 2

shejxoff@yandex.ruDanilovA. A.ДаниловА. А.
Russian Federation
DyrdikM. B.ДырдикМ. Б.
Russian Federation
AmoevZ. V.АмоевЗ. В.
Russian Federation
LedyaevD. S.ЛедяевД. С.
Russian Federation
LyubarskayaYu. O.ЛюбарскаяЮ. А.
Russian Federation
RykhtikP. I.РыхтикП. И.
Russian Federation
ShatokhinaI. V.ШатохинаИ. В.
Russian Federation
Nizhniy Novgorod State Medical Academy, Ministry of Health of RussiaФГБОУ ВО «Нижегородская государственная медицинская академия» Минздрава РоссииVolga District Medical Center under Federal Medical and Biological Agency of RussiaФБУЗ «Приволжский окружной медицинский центр» ФМБА России3006201713220261812201619022017https://oncourology.abvpress.ru/oncur/article/view/636

Objective. Study of 90 day complications after solitary kidney resection and determination of their dependence on resection complexity level in accordance with the RENAL nephrometry scoring system.

Materials and methods. Seventy (70) resections due to solitary kidney tumors were performed in 65 patients (34 males and 31 females). Mean age was 59.1 years (40–75 years). Fifty-five (55) patients had renal cell carcinoma, 10 patients had benign tumors. According to the RENAL scoring system, in 17 (24 %) cases resection complexity was 4–6 points, in 21 (30 %) cases it was 7–9 points, in 32 (45 %) cases it was 10–12 points. Mean tumor diameter was 4.4 (1.5–10.0) cm. Kidney resection without ischemia was performed in 3 patients, with segmental ischemia – in 39 cases. In 28 (40 %) cases general ischemia was used, its mean duration was 18 (6–48) minutes. Local hypothermia was used in 5 patients. Statistical analysis was performed using SPSS Statistics 16.

Results. Analysis of 90 day complications revealed no complications in 41 (58.6 %) cases, severity grade I complications were observed in 2 (2.9 %) cases, grade II – in 20 (28.6 %), grade III – in 6 (8.6 %); there were no grade IV and V complications. Hemodialysis wasn’t performed. Complications were significantly more frequent when total RENAL points were higher (Mann–Whitney U-test, р = 0.001); a positive correlation between RENAL score and presence of complications was observed (Spearman’s rho 0.411; p <0.001). A dependence between complications severity and RENAL score (Mann–Whitney U-test, р = 0.004) and a positive correlation between complications severity and RENAL score (Spearman’s rho 0.432; p <0,001) were revealed.

Conclusion. Forty-five percent (45 %) of kidney resections were of maximum complexity according to the RENAL scoring system. In 60 % of cases resection was performed without general ischemia. Analysis of the results of solitary kidney resection demonstrated high efficacy and safety of the procedure and dependence of the frequency and severity of complications on complexity level per the RENAL scoring system.

Цель исследования: изучить структуру 90-дневных осложнений после резекции единственной почки и определить зависимость их возникновения от степени сложности резекции по нефрометрической системе R.E.N.A.L.

Материал и методика. 65 пациентам с опухолями единственной почки произведено 70 резекций  почки. Мужчин было 34, женщин – 31 в возрасте 59,1 (40 – 75) лет. У 55 больных был ПКР, у 10 – доброкачественные опухоли. Степень сложности резекции почки по системе R.E.N.A.L. определена: 4-6 баллов - в 17 (24%) случаях, 7–9 – в 21 (30%), 10–12 - в  32 (45%). Средний диаметр опухолей составил 4,4 см (1,5–10 см).  Резекция почки без ишемии осуществлена у 3 больных, в 39 случаях - с сегментарной ишемией. В 28 случаях (40%) применяли общую ишемию, среднее время ишемии составило 18,0 мин (6–48 мин). У 5 больных применяли местную гипотермию. Статистический анализ проведен с использованием SPSS statistics 16.

Результаты. При анализе 90-дневных осложнений установлено: не было осложнений – 41 (58,6%) случаев; I степени –2 (2,9%); II –20 (28,6%); III – 6 (8,6%); IV – 0; V степени – 0. Гемодиализа не было. Осложнения статистически значимо чаще встречались при увеличении балла RENAL (U-test р=0,001), выявлена положительная корреляция между величиной балла RENAL и наличием осложнений (R=0,411, p<0,001). Выявлена зависимость тяжести осложнений от величины RENAL (U-test р=0,004) и положительная корреляция между тяжестью осложнений и баллом RENAL (R=0,432, p<0,001).

Заключение. 45% случаев резекции почки относилось к максимальной степени сложности по системе R.E.N.A.L. В 60% случаев резекцию почки выполняли без общей ишемии. Анализ результатов резекции единственной почки показал их высокую эффективность и безопасность и зависимость частоты и тяжести осложнений от степени сложности резекции по системе RENAL.

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