POSSIBILITIES OF LAPAROSCOPY IN THE COMBINED SURGICAL PATHOLOGY IN PATIENTS WITH RENAL CARCINOMA AT ELDERLY AND OLD AGE

O.E. LUSEVIS, E.V. KAMILOV

The 1 Moscow State Medical and Dental University, Moscow, RUSSIA

The aim of our study: is to evaluate effectiveness of surgical treatment by laparoscopic method in patients at elderly and old age with different combined pathologies.

Materials and Methods: We analyzed surgical treatment in 20 patients with renal carcinoma at aged between 61-75 years with various concomitant surgical pathology. All patients were performed surgical treatment by laparoscopic technique. Patient K., 75, was admitted with a diagnosis of perforation of the sigmoid colon diverticulum, diffuse peritonitis. Urgent laparoscopic intervention with obstructive resection of the sigmoid colon with the removal of colostoma was performed. In the course of examination it was revealed that patient had cancer of the left kidney. Postoperative period was smooth. The drain was removed on the 3^rd day. The patient was discharged on the 5^th day in satisfactory condition. 2.5 months later the patient underwent laparoscopic radical nephrectomy and laparoscopic closure of the colostomy. On the 7^th day after surgery the patient was discharged from the hospital in satisfactory condition. The patient I., 61, was admitted with a diagnosis of urolithiasis, right renal calculus. The patient was performed nephroscopy from right with litholapaxy. Because of the pronounced inflammation in the area of ​​operations, it was impossible to insert a stent. In the course of examination there was revealed that the patient had cancer of the left kidney. On the first postoperative days there was performed replacement because of the lack of the functions of nephrostomic drainage. The postoperative period was without complications, the patient was discharged home on the 3^rd day. A month later the patient was performed left laparoscopic radical nephrectomy. Post-operative period was smooth, the drain was removed on the 2^nd day. On the 4th day the patient was discharged home. A month after the second surgery, the patient was performed laparoscopic resection of the pelvi-ureteral segment of the only right kidney, pyeloureteroanastomosis on stent. The drain was removed on the 15^th day, the patient was discharged home in a satisfactory condition on the 17^th day. Nephrostomy is functional. In 12 patients there was carried out simultaneous laparoscopic cholecystectomy with laparoscopic radical nephrectomy. 6 patients were performed laparoscopic hysterectomy and laparoscopic radical nephrectomy. In all cases the postoperative period was without complication, all the patients were discharged on the 5-6^th day.

Conclusions: the use of the laparoscopic method in patients at elderly and old age with different combined surgical pathology is quite justified intervention that makes it possible to improve significantly the immediate results of surgical treatment and quality of life of a patients in long-term period.

Date: 2014-12-28; view: 795