urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.2.65NRTGRTurmj-1497Research ArticleОригинальные статьи | Original articlesOriginal articlesНефротрансплантатэктомия с применением рентгенхирургических методовNephrotransplantectomy Using Radiosurgical Techniqueshttps://orcid.org/0009-0003-1867-437XАхтямовР. Р.AkhtyamovR. R.

Рустем Рашитович Ахтямов — заведующий хирургическим отделением № 3, Окружная клиническая больница; аспирант, Ханты-Мансийская государственная медицинская академия

Ханты-Мансийск

Rustem R. Akhtyamov — Head of the Surgical Department No. 3, District Clinical Hospital; Postgraduate Student, Khanty-Mansiysk State Medical Academy

Khanty-Mansiysk

Ahtyamovrr@okbhmao.ruhttps://orcid.org/0009-0008-1631-1037ИонинВ. П.IoninV. P.

Владимир Петрович Ионин — доктор медицинских наук, заведующий кафедрой общей и факультетской хирургии

Ханты-Мансийск

Vladimir P. Ionin — Doctor of Sciences (Medicine), Head of the Department of General and Faculty Surgery

Khanty-Mansiysk

ionin.55@mail.ruОкружная клиническая больница; Ханты-Мансийская государственная медицинская академияРоссияDistrict Clinical Hospital; Khanty-Mansiysk State Medical AcademyRussian FederationХанты-Мансийская государственная медицинская академияРоссияKhanty-Mansiysk State Medical AcademyRussian Federation2024100520242326575Copyright © Ахтямов Р.Р., Ионин В.П., 20242024Ахтямов Р.Р., Ионин В.П.Akhtyamov R.R., Ionin V.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1497Введение

Введение. После потери функции трансплантата почки курация пациентов может быть сложной задачей. Методом выбора между редукцией иммуносупрессии с оставлением нефункционирующего трансплантата почки и эмболизацией является нефротрансплантэктомия (НТЭ). Это операция с потенциально значимыми показателями кровопотери, осложнений и летальности. Наряду с традиционной НТЭ мы стали использовать эндоваскулярную изоляцию аллотрансплантата как метод предоперационной подготовки перед его удалением.

Цель работы — исследовать влияние применения рентгенхирургических малоинвазивных методик на хирургическую тактику НТЭ, степень кровопотери, частоту осложнений и переливания крови.

Материалы и методы

Материалы и методы. Проведен ретроспективный анализ данных 52 пациентов после НТЭ. В зависимости от методики пациенты разделены на две группы. В группе 1 (основной, n = 22) операция проводилась с предварительно проведенной эндоваскулярной эмболизацией артерий трансплантата (ЭЭАТ), в группе 2 (контрольной, n = 30)— без ЭЭАТ. Проведен анализ результатов обследования, интра- и послеоперационных показателей у пациентов по группам.

Результаты

Результаты. В группе 1 интраоперационная кровопотеря составила 10–80 мл, в среднем (35,4±19,9) мл; в группе 2 — от 100 до 600 мл, всреднем (289,7±138,4) мл (p < 0,001). В группе 2 чаще (n = 4) (13,3 % против 0 %) происходили повреждения магистральных сосудов, для коррекции постгеморрагической анемии в53,3 % случаев (n = 16) проводились гемотрансфузии. Послеоперационные осложнения в контрольной группе фиксировались у 8больных (26,7 %).

Обсуждение

Обсуждение. Превентивная эндоваскулярная эмболизация артерий трансплантата почки существенно снижает частоту интра- и послеоперационных осложнений, позволяет производить нефрэктомию в плановом порядке и в отсроченные сроки.

Introduction

Introduction. Aſter the loss of kidney transplant function, patient curation can be a difficult task. Nephrotransplantectomy (NTE) is the method of choice between reduction of immunosuppression with the abandonment of a non-functioning kidney transplant and embolization. This is an operation with potentially significant indicators of blood loss, complications and mortality. Along with traditional NTE, we began to use endovascular isolation of the allograſt as a method of preoperative preparation before its removal.

The aim of the work is to investigate the effect of the use of radiosurgical minimally invasive techniques on the surgical tactics of nephrotransplantectomy, the degree of blood loss, the frequency of complications and blood transfusion.

Materials and methods

Materials and methods. A retrospective analysis of the data of 52 patients aſter NTE was performed. Depending on the method, patients are divided into two groups. In group 1 (main, n = 22), the operation was performed with pre-performed endovascular embolization of the graſt arteries (EEAT), in group 2 (control, n = 30) — without EEAT. The analysis of the results of the examination, intra- and postoperative indicators in patients by groups was carried out.

Results

Results. In group 1, intraoperative blood loss was 10–80 ml, on average (35.4±19.9) ml; in group 2 — from 100 to 600 ml, on average (289.7±138.4) ml (p < 0.001). In group 2, damage to the main vessels occurred more oſten (n = 4) (13.3 % vs. 0 %), hemotransfusion was performed in 53.3 % of cases (n = 16) to correct posthemorrhagic anemia. Postoperative complications in the control group were recorded in 8 patients (26.7 %).

Discussion

Discussion. Preventive endovascular embolization of the arteries of a kidney transplant significantly reduces the frequency ofintra- and postoperative complications, allows nephrectomy to be performed on a planned basis andin a delayed manner.

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The authors declare that there are no conflicts of interest present.