Parcijalna nefrektomija

master's thesis

• Title (english): Partial nephrectomy
• Author: Ivan Puđa
• Mentor: Nikola Knežević (mentor)
• Committee member: Tvrtko Hudolin (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Nikola Knežević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Urology); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology

Abstract

Parcijalna nefrektomija već dugo je zlatni standard u liječenju manjih tumorskih promjena bubrega. Danas su u upotrebi otvoreni, laparoskopski i robotski asistirani laparoskopski pristup. Razvojem radioloških metoda i njihovim sve učestalijim korištenjem, posebice primjene ultrazvuka, danas se sve češće tumori bubrega otkrivaju u ranom T1a stadiju, kada su manji od 4 cm. To je dovelo i do povećanja broja parcijalnih nefrektomija i usavršavanja kirurških tehnika. U počecima je parcijalna nefrektomija bila indicirana kod bolesnika sa solitarnim bubregom, bilateralnim tumorima i smanjenom bubrežnom funkcijom. Usavršavanjem i razvojem kirurških tehnika, indikacije za parcijalnu nefrektomiju proširene na sve tumore T1a stadija. To je osobito korisno kod dijela bolesnika s patohistološkom dijagnozom benignog ili nisko malignog tumora bubrega u čijem bi slučaju radikalna nefrektomija bila preintenzivan zahvat. Parcijalnom nefrektomijom postiže se očuvanje bubrežne mase, a time i očuvanje bubrežne funkcije te smanjenje rizika od bubrežnog zatajenja. Očuvanjem bubrežne funkcije postiže se i prevencija kardiovaskularnih bolesti te poboljšanje kvalitete života. Osnovni je cilj razvoja kirurških tehnika skraćenje vremena ishemije bubrega i što manje oštećenje preostalog bubrežnog parenhima kako bi se postiglo što bolje očuvanje bubrežne funkcije. Pored toga razvijaju se minimalno invazivni pristupi parcijalnoj nefrektomiji, tehnike smanjenja perioperativnog gubitka krvi te tehnika smanjenja učestalosti pozitivnih rubova, a time i recidiva. Parcijalna nefrektomija trenutno predstavlja prvi izbor u liječenju malih tumora bubrega, posebice ona izvedena minimalno invazivnim tehnikama.

Abstract (english)

Partial nephrectomy has been a gold standard in treatment of small kidney tumors for some time now. Open, laparoscopic and robot-assisted laparoscopic approach are in use today. With development of radiological methods and their more frequent use, especially the use of an ultrasound, the tumors of kidney are detected in early T1a stage, when they are smaller than 4 cm, more frequently today. That lead to increase in number of partial nephrectomies and to improvement of surgical techniques. In the beginnings, partial nephrectomy was indicated in patients with solitary kidney, bilateral tumors and impaired renal function. With development of surgical techniques, indications for partial nephrectomy spread to all T1a stage tumors. That is particularly useful in some of the patients who have pathohistological diagnosis of benign or low malignant kidney tumors in which case the radical nephrectomy would be an overtreatment. Partial nephrectomy achieves the preservation of kidney mass due to which the renal function is also preserved and renal failure risk is decreased. With preservation of renal function, the prevention of cardiovascular diseases and better quality of life are also achieved. The main goals of surgical techniques development are shortening the ischemia time and reducing the damage of the remaining renal parenchyma in order to achieve the better preservation of renal function. Aside from that, the minimally invasive approaches are developed, just as techniques for lesser blood loss and techniques for reduction in frequency of positive margins and relapses. Currently, partial nephrectomy is the first choice in small renal tumor management, especially if done with minimally invasive technique.

• Keywords: parcijalna nefrektomija; tumori bubrega; mali tumori bubrega; bubrežna funkcija; ishemija bubrega; minimalno invazivni pristupi
• Keywords (english): partial nephrectomy; renal tumors; small renal tumors; renal function; renal ischemia; minimally invasive approaches
• Language: croatian
• URN:NBN: urn:nbn:hr:105:902973
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-09 12:04:00