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Modern predstvlenija about surgical methods of treatment of patients with tumours of kidneys (the literature review)

The first mentions about organosohranjajushchih operative treatments of tumours of kidneys in the literature meet from the beginning of 19 centuries. J.Koning (1826) and A. Robin (1855) have described tumours of kidneys which they have found out at opening.

G. Simon (1869) has executed for the first time a nephrectomy concerning a prospective tumour, but in a kidney it has not taped. In Russia for the first time has carried out a nephrectomy concerning a tumour in 1886 Oryol. The first on successful excision of a tumoral thrombus from NPV during nephrectomies have informed in 1943 J.R. McDonald and J.T. Priestly. In Russia the first successful thrombectomy from NPV was executed in 1949 by A.V.Smirnov (Pereeerzev A.S., 1997).

For the first time a nephrectomy concerning a tumour (fibrolipoma) in 1884 has executed Wells, and in 1887 N.E. Czегnу (Schabel S.I, 1986.) Has made the first nephrectomy at its lesion a malignant tumour (angiosarcoma). OSO at kidney tumours further have not received a wide circulation because of imperfection of technics of operation, a considerable quantity of postoperative complications against satisfactory results of radical nephrectomies. In 1950 V.Vermooten for the first time has proved functional validity of a nephrectomy at neoplasms (Vermooten V.I., 1950). However in 1963 C.J. Robson and co-authors, being based on a clinical material, declared a radical nephrectomy gold standard operation at revealing at the patient of a tumour of a kidney (Robson C.J., 1963). Long time was considered, that the most adequate treatment localised and mestnorasprostranennogo RP is the radical nephrectomy including excision of a kidney by the uniform block with a tumour, a surrounding fatty tissue, an adrenal and fascias within fascia Gerota with regionarnoj limfodissektsiej (Robson C.J. Churchill B.M., 1969). In the sixties

The XX-th century the given statement has not caused any discussions as in a diagnostic arsenal of clinicians there were no those techniques which at a preoperative stage would allow to define precisely prevalence of tumoral process, character of a neoplasm and its mutual relation with surrounding tissues. Besides, the operative technics of a nephrectomy has not been still developed enough at tumours. In this connection, within the next two decades organosohranjajushchie operations were carried out only in unusual cases at functionally unique kidney or a pathology kontralateralnoj kidneys (Harry W.H., 2005). Further necessity of performance of a nephrectomy of small bagged tumours of a kidney has been called into question.

In 80 years of the XX-th century, when introduction in clinical practice of new methods of diagnostics has begun (ultrasonic, SKT, MRT), many urologists began to prefer organosohranjajushchej to tactics of treatment of neoplasms of a kidney of early stages (Т1), even if function of an opposite kidney has been kept (that is on elektivnym to indications) (Harry W.H., 2005).

Studying of operative surgery of kidneys convinces us of historical development that already for a long time the aspiration of surgeons/urologists was conservation of the most valuable for an organism of a renal tissue.

In the literature a lot of attention is given experimental and clinical researches of kidneys with excision of this or that quantity of their parenchyma. The red thread in these researches spends thought on necessity of use organosohranjajushchej operations with limiting conservation of a healthy parenchyma since 50th years of the XX-th century (Ortega F.E., 1951; A.J.Abramjan, 1962, etc.).

Rising of frequency of revealing at early stages of tumours of the given localisation allows to carry out a nephrectomy to the increasing number of patients. As a result of it now larger percent of patients

Are candidates for organosohranjajushchego treatment which favourably differs from a radical nephrectomy on variety of positions.

Organosohranjajushchee treatment began to be used widely when a number of researchers have shown, that oncologic results of such operations are not worse, than after a radical nephrectomy. According to some authors, the specific survival rate after a nephrectomy concerning a tumour varies approximately within 89-97 % (table 1).

Last two decades heightened interest to organosohranjajushchemu to treatment of a tumour of a kidney, as well as to working out of more certain indications to the given kind of operations, kinds of operative grants, techniques is shown.

Table 1

Comparison of oncologic results of a resection of a tumour of a kidney.

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A source: Hamitov Denis Dinarovich. Tactics of surgical treatment of patients with bilateral tumors of the kidneys, a tumor of a single kidney and patients with a kidney tumor in combination with chronic kidney diseases on the opposite side. Thesis for the degree of candidate of medical sciences. Kazan 2014. 2014

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