ART OF MEDICINE 2017
URGENT SELECTIVE EMBOLIZATION OF RENAL ARTERIES AS A METHOD OF SELECTION OF EMERGENCY PALIATIVE AID IN PROFUSE HEMATURIA CASES IN PATIENTS WITH INCURABLE TUMOR OF KIDNEY
I. Bilyk2, R. Antoniv1, O. Sovtus1, V. Pjatnychuk21
1SHEI «Ivano-Frankivsk National Medical University», Ivano-Frankivsk, Ukraine
Abstract. Over the past 15 years, new techniques for interventional radiology and minimally invasive surgery have been introduced into clinical practice. This has increased the range of possible methods of palliative care for patients in the last stages of malignant neoplasms of the kidneys, when radical treatment is impossible. The greatest problem of such patients that causes irreversible processes in the patient's body are frequent, profound hematuria, which are difficult to regulate medically and caused by severe post-heremorrhagic anemia. The method of selective embolization of the renal arteries (SERA) is a variant of palliative emergency care to stop profuse hematuria in this contingent of patients.
The purpose of the study is to analyze the effectiveness of SERA in the palliative care of patients with malignant kidney formation.
Materials and methods. In the period from 2012 to 2017, 43 patients with renal cancer T4N1M0-1 were examined and treated in the urological department of the Ivano-Frankivsk Central City Clinical Hospital, which were treated urgently with a profuse macro hematuria. Verification of the diagnosis of neoplasm was carried out according to industry diagnostic standards. Initially, all patients received standard hemostatic therapy. In 3 patients, massive hematuria was observed for the first time. In 10 patients, hematuria was repeated after a medically corrected drug with a positive effect. In other 9 patients, hematuria was intermittent (more than 2 times in 3 months) and the effect of hemostatic therapy was not achieved. One patient had recurrent hematuria, which arose 4 months after the previous nonselective embolization of the general renal artery. 23 patients who did not respond to conservative hemostatic therapy were treated with SERA. This group consisted of 15 men and 8 women. The average age of patients was 62 ± 5.5 years. In 14 patients, the tumor was in the right renal, and 9 in the left one. The average size of the tumor was 12.5 ± 3 cm. During angiography, the main vascular trunk of the kidney was visualized, which allowed the surgeon to adequately conduct selective vascular embolization of the tumor.
Results and discussion. The main result of SERA was the cessation of hematuria in 100% of patients undergoing a procedure that further helped adjust the degree of anemia. An important effect was to improve the psychological state of patients who stopped hematuria. The duration of stay in the hospital of patients after SERA was on average 3 days, and patients with the same pathology only on drug treatment - 14 days.
Conclusions. 1. Selective embolization of the renal artery may be used in patients with common kidney cancer as a palliative emergency during intense hematuria, prolonged recurrent hematuria.
2. The wide introduction into the medical process of SERA provides the opportunity to extend the duration and quality of life of patients with inoperable kidney tumors, reduces the timing and frequency of such patients in the hospital.
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