Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press64510.17650/1726-9776-2017-13-1-45-52DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиEarly functional outcomes of nephron sparring surgery for renal masses in the solitary kidneyРанние функциональные результаты хирургического лечения опухолей единственной почкиSuslovL. N.СусловЛ. Н
Belarus

Контакты: Леонид Николаевич Суслов - научный сотрудник

223040 Минский район, агрогородок Лесной

 

leonid.n.suslov@gmail.comSukonkoO. G.СуконкоО. Г.
Belarus
KraskoO. V.КраськоО. В.
Belarus
PolyakovS. L.ПоляковС. Л.
Belarus
N.N. Alexandrov National Cancer Center of BelarusРеспубликанский научно-практический центр онкологии и медицинской радиологии им. Н.Н. АлександроваUnited Institute of Informatics Problems, National Academy of Sciences of BelarusОбъединенный институт проблем информатики Национальной академии наук Беларуси3003201713145520701201713022017https://oncourology.abvpress.ru/oncur/article/view/645

Background. Tumors of a solitary kidney (SK) are extremely rare. They are an absolute indication for organ-preserving treatment. Decrease in the glomerular filtration rate (GFR) and development of acute kidney injury in early postoperative period often require hemodialysis, and patients have to stay in the ICU.

Objective. Evaluation of short-term functional results and identification of factors affecting GFR decrease in the early postoperative period after partial nephrectomy for renal masses in the SK.

Materials and methods. Analysis of patients’ data with tumor of the SK who underwent open partial nephrectomy at the Oncourology Department of the N.N. Alexandrov National Cancer Centre ofBelarus in the period of 16 years was performed. The study included 136 patients.

Results. Multifactor regression analysis (including potential risk factors) revealed that the GFR decrease in the early postoperative period significantly correlated with multifocality (p = 0.028-), ischemia (p < 0.001), blood transfusion (p < 0.001), and the maximum tumor size (p = 0.006). Additional analyses didn’t show any statistically significant correlations between decrease of kidney function and duration of the SK status (n = 127; p = 0.31) or the volume of preserved parenchyma (n = 82; p = 0.77).

Conclusion. Early GFR decrease after partial nephrectomy of the SK is strongly associated with ischemia time, blood transfusion, tumor size, and multifocality. In this study, the volume of preserved parenchyma didn’t affect early functional results of the surgery. 

Введение. Опухоль единственной почки (ЕП) встречается крайне редко и является абсолютным показанием к органосохраняющему лечению. Снижение скорости клубочковой фильтрации (СКФ) и развитие острой почечной недостаточности в раннем послеоперационном периоде часто требует проведение сеансов гемодиализа и нахождение пациента в отделении реанимации.

Цель работы – оценка ближайших функциональных результатов резекции ЕП, выявление факторов, влияющих на степень снижения СКФ в раннем послеоперационном периоде.

Материалы и методы. Проведен анализ данных пациентов, прооперированных в отделении онкоурологии РНПЦ ОМР им. Н.Н. Александрова за 16 лет с опухолью ЕП. Всего в исследование включено 136 пациентов.

Результаты. По данным мультифакторного регрессионного анализа с  включением потенциальных факторов риска установлено, что статистически значимая корреляция со степенью снижения СКФ в раннем послеоперационном периоде отмечалась с мультифокальностью (p=0,028), длительностью ишемии (p < 0,001), гемотрансфузией (p < 0,001) и наибольшим размером опухоли (p=0,006). При выполнении дополнительных анализов данных не было выявлено статистически значимого влияния на степень снижения функции почки ни длительности статуса единственной почки (n=127, p=0,31), ни объёма сохраненной паренхимы (n=82, p=0,77).

Заключение. Установлена статистически значимая связь длительности ишемии,  гемотрансфузии в интра- или послеоперационном периоде, размера опухоли и мультифокальности со степенью снижения почечной функции в раннем послеоперационном периоде после резекции ЕП. В данной работе объём сохраненной паренхимы не оказал влияния на ранние функциональные результаты операции.

 

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