Hirurško lečenje tumora bubrega sa tumorskim trombom u donjoj šupljoj veni

  • Aleksandar Tomić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Aleksić Predrag Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Novak Milović Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Radoje Ilić Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Ivan Marjanović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Vladimir Bančević Military Medical Academy, Clinic for Urology Belgrade, Serbia
  • Ivan Leković Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Vojislava Nešković Military Medical Academy, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia
  • Vladimir Mandarić Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Zoran Kostić Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia
  • Momir Šarac Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Petar Vukićević Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Boško Milev Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia
  • Dragana Paunović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Aleksandar Zarić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Dragana Jovanović Military Medical Academy, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia
  • Dragan Sekulić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Luka Babić Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Radivoj Zoranović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP220130058T
Ključne reči: bubreg, neoplazme, neoplazme, metastaze, v. cava inferior, hirurgija, operativne procedure, preživljavanje

Sažetak


Uvod/Cilj. Agresivan pristup sa radikalnom nefrektomijom i trombektomijom je osnova lečenja bolesnika sa tumorom bubrega. Cilj rada bio je da se prikažu rezultati takvih hirurških zahvata, sprovedenih tokom poslednjih 25 godina u našoj ustanovi. Metode. Izvršena je retrospektivna analiza radikalne nefrektomije i trombektomije kod bolesnika sa tumorom bubrega i tumorskim trombom (TT) koji se protezao u donju šuplju venu (DŠV). Prikazani bolesnici su lečeni u našoj ustanovi između januara 1995. i oktobra 2021. godine. Rezultati. U navedenom periodu operisana su 92 bolesnika (72 muškarca i 20 žena), prosečne starosti od 60,5 godina. Kod 73,33% bolesnika postojala je predominacija desnostranog tumora. Bolesnici sa TT u bubrežnoj veni (nivoa 0 i I) nisu bili uključeni. Nivoi TT II, III i IV bili su prisutni kod 32 (34,8%), 52 (56,5%) i 8 (8,7%) bolesnika, redom. Jedan bolesnik imao je tromb u desnoj plućnoj arteriji. Četiri bolesnika imala su metastaze u jetri, a kod deset bolesnika bili su zahvaćeni limfni čvorovi. Hirurški pristup subkostalnom incizijom bio je postignut kod 8 (8,69%) bolesnika, chevron rezom kod 11 (11,95%) bolesnika, dok je kod 73 (79,34%) bolesnika bila urađena sternotomija i subkostalna/chevron incizija. Intraoperativno, postojala je jedna komplikacija u vidu plućne tromboembolije. Kod šest bolesnika bilo je potrebno izvršiti reoperaciju zbog krvarenja iz operativne rane. Trogodišnje preživljavanje bolesnika sa tumorom bubrega i TT nivoa II−IV u DŠV iznosilo je 43%. Zaključak. Operacija će ostati primarni metod lečenja bolesnika sa tumorom bubrega i TT u DŠV. Dugotrajno preživljavanje tih bolesnika može se postići samo potpunim hirurškim uklanjanjem (radikalna nefrektomija i trombektomija).

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2023/05/03
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Vol. 80 Br. 04 (2023): Vojnosanitetski pregled
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Originalni članak