medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1244medvis-1309Research ArticleПОЧКИ. Специальная сессия под редакцией профессора А.И. ГромоваKIDNEYS. Special session edited by professor A.I. GromovРадиочастотная термоабляция (РЧА) у больных раком почкиRadiofrequency thermoablation (RFA) in kidney cancer patientshttps://orcid.org/0000-0002-2348-4963СтепановаЮ. А.StepanovaYu. A.

Степанова Юлия Александровна – доктор мед. наук, ученый секретарь

117997 Москва, ул. Большая Серпуховская, д. 27

 Тел.: +7-499-236-60-94 

Yulia A. Stepanova – Doct. of Sci. (Med.), the Scientific Secretary

27, Bol'shaya Serpukhovskaia str., Moscow 117997

 Phone: +7-499-236-60-94 

stepanovaua@mail.ruhttps://orcid.org/0000-0002-8598-8008ЖаворонковаО. И.ZhavoronkovaO. I.

Жаворонкова Ольга Ивановна – канд. мед. наук, старший научный сотрудник отделения ультразвуковой диагностики

117997 Москва, ул. Большая Серпуховская, д. 27

Olga I. Zhavoronkova – Cad. of Sci. (Med.), the senior research of ultrasound diagnostics department

27, Bol'shaya Serpukhovskaia str., Moscow 117997

https://orcid.org/0000-0003-0716-5353ГавриловЯ. Я.GavrilovYa. Ya.

Гаврилов Ян Янович – младший научный сотрудник отделения ультразвуковой диагностики

117997 Москва, ул. Большая Серпуховская, д. 27

Yan Ya. Gavrilov – the junior researcher of ultrasound diagnostics department

27, Bol'shaya Serpukhovskaia str., Moscow 117997

https://orcid.org/0000-0002-0576-4988ЧехоеваО. А.ChekhoevaO. A.

Чехоева Олеся Ахсаровна – младший научный сотрудник отделения ультразвуковой диагностики

117997 Москва, ул. Большая Серпуховская, д. 27

Olesya A. Chekhoeva – the junior researcher of ultrasound diagnostics department

27, Bol'shaya Serpukhovskaia str., Moscow 117997

https://orcid.org/0000-0002-5160-925XГрицкевичА. А.GritskevichA. A.

Грицкевич Александр Анатольевич – доктор мед. наук, старший научный сотрудник отделения урологии

117997 Москва, ул. Большая Серпуховская, д. 27

Aleksandr A. Gritskevich – Doct. of Sci. (Med.), the senior research of Urology department

27, Bol'shaya Serpukhovskaia str., Moscow 117997

https://orcid.org/0000-0002-6904-9318ГлотовА. В.GlotovA. V.

Глотов Андрей Вячеславович – врач-патологоанатом отделения патологической анатомии

117997 Москва, ул. Большая Серпуховская, д. 27

Andrey V. Glotov – pathologist of pathology department

27, Bol'shaya Serpukhovskaia str., Moscow 117997

ФГБУ “Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского” Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian FederationRussian Federation20232812202227199119Copyright © Степанова Ю.А., Жаворонкова О.И., Гаврилов Я.Я., Чехоева О.А., Грицкевич А.А., Глотов А.В., 20232023Степанова Ю.А., Жаворонкова О.И., Гаврилов Я.Я., Чехоева О.А., Грицкевич А.А., Глотов А.В.Stepanova Y.A., Zhavoronkova O.I., Gavrilov Y.Y., Chekhoeva O.A., Gritskevich A.A., Glotov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1309

Цель исследования: оценить собственные непосредственные результаты проведения радиочастотной абляции (РЧА) опухолей почки в НМИЦ хирургии им. А.В. Вишневского.Материал и методы. В исследование вошли результаты обследования и лечения 22 пациентов с опухолями почки, находившихся на лечении в Национальном медицинском хирургическом центре им. А.В. Виш невского (16 мужчин и 6 женщин в возрасте от 40 лет до 81 года, средний возраст – 61,5 года). Всем пациентам дооперационно выполняли УЗИ, МСКТ с контрастным усилением. На различных этапах лечения пациентам выполняли РЧА опухоли почки на приборе Radionics Cool-Tip ® Ablation System (США). В послеоперационном периоде всем пациентам проводили МСКТ-мониторинг состояния опухоли с контрастным усилением и УЗИ с дуплексным сканирование, а также УЗИ с контрастным усилением – 7 пациентам и МРТ с контрастным усилением в 1-е сутки после вмешательства – 5 пациентам. Динамическое наблюдение проводили в послеоперационном периоде в сроки от 3 до 60 (медиана 17,8) мес.Результаты. В зависимости от хирургической тактики, больных условно разделили на две группы: первая (16 больных) – РЧА выполняли как первый самостоятельных этап лечения; вторая (6 больных) – РЧА выполняли как этапное лечение при резекции почки. Опухоль была солитарной у 19 больных обеих групп, множественной – у 3.У опухолей больных первой группы при размерах, превышающих 30,0 мм в диаметре, был получен положительный эффект от проведенной манипуляции: прогрессии опухоли не было выявлено при динамическом наблюдении. Этим больным выполняли от 2 до 3 сеансов РЧА. У опухолей больных второй группы размеры не превышали 30,0 мм, выполняли от 2 до 4 сеансов (в среднем 3 сеанса) РЧА, что было обусловлено множественным поражением в 3 случаях.Применение РЧА при лечении больных с малым раком почки, имеющих сопутствующие заболевания, не позволяющие провести радикальное лечение, позволило получить безрецидивный период, в среднем равный 16,5 мес. Применение же РЧА, как этапа лечения первично-множественного рака почки, показало безрецидивный период в среднем 21,2 мес.Заключение. Применение РЧА при лечении рака почки позволяет значительно расширить объем оказываемой хирургической помощи как у пациентов с первично-множественным раком обеих почек в качестве этапного лечения, так и при лечении пациентов с наличием сопутствующих заболеваний, не позволяющих выполнить оперативное вмешательство значительного объема.

The aim: to evaluate the own direct results of the RFA of kidney tumors in A.V. Vishnevsky National Medical Research Center of Surgery.Materials and methods. The study included the results of examination and treatment of 22 patients with kidney tumors treated at A.V. Vishnevsky National Medical Center of Surgery (16 men and 6 women aged 40 to 81, mean age 61.5 years). All patients underwent preoperative ultrasound, MSCT with contrast enhancement., Patients underwent RFA of kidney tumors using the Radionics Cool-Tip ® Ablation System (USA) at various stages of treatment In the postoperative period, all patients underwent MSCT monitoring with contrast enhancement and ultrasound with duplex scanning, as well as ultrasound with contrast enhancement – in 7 patients and MRI with contrast enhancement on the first day after the intervention – in 5 patients. Dynamic follow-up was performed in the postoperative period from 3 to 60 months (median 17.8 months).Results. Depending on the surgical tactics, the patients were divided into two groups: the first (16 patients) – RFA was performed as the first independent stage of treatment; the second (6 patients) – RFA was performed as a staged treatment for kidney resection.The tumor was solitary in 19 patients of both groups, multiple – in 3. In tumors of the first group, with sizes exceeding 30.0 mm in diameter, a positive effect was obtained from the manipulation: no progression of the tumor was detected during dynamic observation. These patients underwent 2 to 3 RFA sessions. In tumors of the second group, the size did not exceed 30.0 mm, 2 to 4 sessions (on average 3 sessions) of RFA were performed, which was due to multiple lesions in 3 cases.The use of RFA in the treatment of patients with small kidney cancer in patients with concomitant diseases that do not allow for radical treatment, made it possible to obtain a relapse-free period of an average of 16.5 months. The use of RFA, as a stage in the treatment of primary multiple kidney cancer, showed a relapse-free period of an average of 21.2 months.Conclusion. The use of radiofrequency ablation in the treatment of kidney cancer patients can significantly expand the scope of surgical care, both in the case of patients with concomitant diseases that do not allow a significant amount of surgical intervention, and in the treatment of patients with primary multiple cancer of both kidneys as a stage treatment.

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