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Rentgenoendovaskuljarnaja an occlusion of vessels of tumours of kidneys

During the period with 2004 till November, 2013 in unit of transplantation of kidney GAUZ RKB MZ RT 242 patients with a tumour of a kidney were observed and from them to 12 patients the occlusion of vessels is executed rentgenoendovaskuljarnaja.

The angiography is used when the exact information on quantity of renal arteries and vascular arhitektonike kidneys is required. On angiograms estimated the sizes of pathological formation, and also sources and character of blood supply of a tumour (a drawing 31, 32).
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Drawing 31. An angiography of the right renal artery. On an angiogram pathological vascularization in a projection of the bottom third of kidney is defined.

Drawing 32. Superselective renal arte - riogramma (3D) at a right kidney tumour: in a zone of a locating of a tumour are defined insignificant quantity of vessels.

At a gross hematuria as the first stage before a nephrectomy concerning a tumour, carried out superselective embolization of tumoral vessels (a drawing 33-34).

Occlusion carried out so that the embolizing material has not got to arteries, krovosnabzhajushchie a healthy tissue of a kidney. In quality embolizatov used particles polivinilalkogolja. If necessary in addition entered fragments of a metal spiral. Procedure considered adequately executed if on control angiograms absence of a blood flow in pathological formation was defined at conservation of blood supply of a healthy tissue of a kidney.

Drawing 33. Embolization of a bleeding vessel of an angiomyolipoma of a right kidney (fragments of a metal spiral are specified by a finger).

Drawing 34. An arteriography before selective embolization of a tumour of a left kidney. 1 — an angiogram before embolization: in a projection of the bottom segment a tumour of 4*5 sm; 2 — an angiogram after embolization: vaskuljazatsija in a tumour projection is absent, arteries of a healthy tissue are kept (marksmen).

After procedure estimated expression postembolizatsionnogo a syndrome. For definition of a functional condition of the rest of a renal parenchyma, within 1-2 weeks defined biochemical indicators of blood serum. Hospitalisation terms have made 7-10 days. In 6 months patients passed control inspection at which according to ultrasonic research and-or a computer tomography dynamics of the sizes of formation was estimated, and on biochemical indicators of blood, renograms — a functional condition of kidneys.

Complications after embolization it has not been noted. postembolizatsionnyj the period was accompanied by moderate nephralgias within 4 days at 5 patients.

All symptoms have passed independently and have not demanded medicamental correction. The gross hematuria at patients has stopped for the second days after embolization. At 2 patients urea and creatinine slight increase became perceptible. Average indexes of urea before procedure have made 4,5 mmol/l, and in 1 and 2 weeks after endovaskuljarnogo interventions — 4,5 and 6,5 mmol/l. Creatinine indicators in similar terms have made 69 and 72 mkmol/l.

In 1 month after embolization all patients have noted improvement of state of health, disappearance of pains. Reduction of volume of a tumour by 25 % is noted at 2 patients, and in the remained cases process stabilisation was observed.

According to a control angiography, after the first embolization it has been reached full devaskuljarizatsija tumours.

Now 8 from 9 patients are live and are in a remission condition in terms from 1 year till 3 years. One patient has died in 7 months after embolization of a dissimination of the tumoral process which has arisen in 3 months after endovaskuljarnoj of procedure.

In a case nerezektabelnoj a tumour expressed to accompanying pathology, refusal of the patient of operative treatment, at gross hematuria occurrence selective embolization of a neoplasm is carried out. However, in the majority of reports single instances (Deutz F.J are described only. Rubben H., Vorverk D., Lutzeyer W., 1988). According to the literature, embolization of a tumour of a kidney is effective enough and safe in a combination with methods of local influence (Sokiranski R., Gorich J., van Ahlen H., 1996).

As show results of a diagnostic angiography, the basic source of blood supply of a tumour are branches of the basic trunk of a renal artery. But in some cases as additional power supplies of a neoplasm additional renal arteries can serve and adrenal, kapsuljarnye, and also. It testifies to necessity careful angiograficheskogo the research including performance of a catheterization of all vessels which can participate in kidney and tumour blood supply.

Clinical observations

1. The patient of 51 years (№ a medical card 13234) has arrived 04.05.10 in unit of transplantation of kidney GAUZ RKB MZ RT with the diagnosis: bilateral agiomiolipomy kidneys.

From the anamnesis in other clinics are executed: 1991г. - on the right a nephrectomy concerning a tumour; 1996 - a right kidney recurrent tumour. 2004 - at the left a nephrectomy on povoduopuholi; 2005 - a left kidney recurrent tumour.

At entering notes complaints to periodic nagging pains in a loin from both parties.

Biochemistry of blood before operation: a creatinine of 89 mmol/l, urea of 5,1 mkmol/l

Ultrasonic of kidneys on which are taped slabogipoehogennye formations of both kidneys is executed. According to SKT kidneys (a drawing 35): the plural

Adenomas of kidneys.

Drawing 35. SKT. Bilateral agiomiolipomy kidneys.

The dynamic renogram (a drawing 36) is executed. The conclusion: function of kidneys the satisfactory.

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12.05.10 embolization of distal branches of an artery of an average segment of a right kidney concerning a tumour under the x-ray control for the purpose of stabilisation of tumoral process (a drawing 37) is executed.

Drawing 37. Embolization of distal branches of an artery of an average segment of a right kidney.

Biochemistry of blood after an angiography: a creatinine of 130 mmol/l, urea of 6,6 mkmol/l.

In November, 2010 the patient arrives again (number of a stationary card 29088) for the purpose of revealing of dynamics of tumoral process. According to ultrasonic, in a right kidney where the occlusion of tumoral vessels is executed, reduction in angiomyolipoma volume on 20 mm becomes perceptible.

It is executed repeated SKT (a drawing 38). The further growth of tumours it is not taped.

Drawing 38. SKT. Bilateral agiomiolipomy kidneys.

It is executed as an angiography of kidneys (a drawing 39). On the right tumour blood supply is absent, in a place of an occlusion from May, 2010.

Drawing 39. A right kidney angiography.

Blood biochemistry: a creatinine of 80 mmol/l, urea of 6,5 mkmol/l.

The patient is written out on dynamic observation of an oncourologist on a residence.

Observation term has made 3 years. Functions of kidneys satisfactory according to renograms (a drawing 40) and laboratory indicators of blood (urea, a creatinine).

2. The patient of 60 years (№ a medical card 14280) has arrived 13.05.10 in unit of transplantation of kidney GAUZ RKB MZ RT with the diagnosis: a tumour of left kidney Т1 аШМ0. A gross hematuria.

At entering noted complaints to a blood impurity in urine with cherveobraznymi clots within last week.

Blood biochemistry: a creatinine of 116 mmol/l, urea of 5,0 mkmol/l.

According to dynamic radioisotope renografii filtrational activity of kidneys (a drawing 40) is slightly lowered.

Drawing 40. A renogram.

According to SKT kidneys (a drawing 41) it is taped formation of an average segment of a left kidney 3,5*4,0 see

Drawing 41. SKT. A left kidney tumour.

31.05.10 the aortography of abdominal department with a selective angiography of the right renal artery with rentgenoendovaskuljarnoj an occlusion of a bleeding renal artery at the left (a drawing 42) is executed.

Biochemistry of blood after an angiography: a creatinine of 99 mmol/l, urea of 6,5 mkmol/l

In 1 month the resection of a right kidney concerning a tumour is executed. Observation term has made 3 years. Urea and creatinine indicators were in norm.

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Drawing 42. An aortography of abdominal department with a selective angiography the right renal artery with rentgenoendovaskuljarnoj an occlusion a bleeding renal artery at the left.

3.1.3

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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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  3. Hamitov Denis Dinarovich Taktika. of surgical treatment of patients with bilateral tumours of kidneys, a tumour of a unique kidney and sick of a kidney tumour in a combination to chronic illnesses of kidneys to an opposite side. The dissertation on competition of a scientific degree of the candidate of medical sciences. Kazan-2014,
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