1
(No Transcript)
2
?

• I. ??????????? ?? ????????????? (?????????????,
  ??????????????) ??????????????? ???
• ?????? ???????????? ? ?? ???????????
  ????????????????? ? ??????????????? ?????????????
  ????? ? ?????????, ?? ???????????
  ???????????????? ????????????? ? ?????????
• ????????? ??????????? ?????????, ?????????? ???
  ?? ??? ?? ????? ????????
• ????????????? ??????????? ?????????????
  ?????????? ? ??????????????? ?????????????
• ?????????? ???????? ????? ?? ?????? ????
• ??????????????? ???? ?????.

3
?

• II. ???? ??????????????? ??????????
  ??????????????, ??
• ?? ?????
• ??????? ?? ??????? ?????- ? ?????????????????
  ??????????
• ??????? ?? ?????????? ??????????.

4
??? ??????????? ??????????? ????????????? ??
?????? ???????????????? ???????????????
?????????? ?? ?????? ???????? ???????????
???????? ??????, ?? ? ????????? ????????????
?????????????? ????????, ??? ????? ??? ????
????????? ??? ?????????? ??????, ????????? ?
??????????? ????????? ??????????
????????????????.
??????? ??????????? ????????????, III ???????,
1981.
5

• ??????? ??????????? ??????????? ??? ???? ?????,
  ??????? ?????????? C.Robson ? ?????. ? 1969 ????,
  ???????? ? ???? ???????? ???? ???????????
  ?????????? ?? ????? ????????? ?? ??????????
  ?????.
• ? ?????? ???????????? ???? ????????, ???
  ??????????????? ????????? ???????????
  ????????????? ????? ????????? ? 23 ??????????,
  ??? ???? 10-?????? ???????????? ?????? ?????????
  ?????????? 35.

Robson C.J., Churchill B.M., Anderson W. The
results of radical nephrectomy for renal cell
carcinoma. J Urol, 1969101297.
6
?? ? ?? ?????, ????? C.Robson ? ??. ?????????
????????????, ??? ?? ???????????? ?? ? ???.
7

• U.Studer ? ?????. (1990) ??????????, ??? ???? ?
  42 ?????????? (n43) ??? ????????? ???????????
  ??????????? ?????????? (?? ?????? ??) ???????? ??
  ????????? ???????? ???????????????? ???? ?????1.
• ? ????????????? ??????? ??? (2005)
  ??????????????? ????????? ??????????? ??????????
  ???? ???????????????? ? 10 ??????? (n493). ?
  ???? ? 39 ?? ??? ?? ?????????????? ?????
  ???????????? ???? ??????????? ??????????
  ????????????? ????? ? ?????????????? ???????2.

1.Studer U.E., Scherz S., Scheidegger J., et al.
Enlargement of regional lymph nodes in renal cell
carcinoma is often not due to metastases. J Urol.
1990144243245. 2.????? ?.?., ???????? ?.?.
????? ??????????????? ? ???????? ??????? ???
??????? ?????. ?.-????? ??? ????????????
??????, 2005. ?. 99-100.
8

• ???????????? EORTC ?? ????????? 30881 (1999)
  ????????, ??? ???????????? ?? ????? ????????
  ????????????? ???? ??? ??????????? ?????? N0
  ?????????? ? 12,8 ?????????? (?336). ??? ????,
  ? 16 ?? ??? ?????????????? ??????????? ???????
  ??????????? ??????????1.
• ????????? ??????????? ????- ? ?????????????????
  ???????????? ?? ????? ????????? ?????????
  ?????????? ??????????????? ????????? ?
  ??????????? ?????????? ??? ???? ?????.

1. Blom, J.H., van Poppel, H., Marechal, J.M.,
Jacqmin, D., Sylvester, R., Schroder, F.H. et al
Radical nephrectomy with and without lymph node
dissection preliminary results of the EORTC
randomized phase III protocol 30881. EORTC
Genitourinary Group. Eur Urol, 1999,36570.
9

• ???????????? EORTC ?? ????????? 30881 (1999)
  ????????, ??? ??? ??????????? ?????? N0
  ?????????????? ? ??????????? ??????????
  ?????????? ? 3,3 ?????????? (n325)1.
• ? ????????????? ??????? ??? (2005) ???????????
  ?????????? ??? ????? 6,3 (n474)2.

1. Blom, J.H., van Poppel, H., Marechal, J.M.,
Jacqmin, D., Sylvester, R., Schroder, F.H. et al
Radical nephrectomy with and without lymph node
dissection preliminary results of the EORTC
randomized phase III protocol 30881. EORTC
Genitourinary Group. Eur Urol, 1999,36570. 2.
????? ?.?., ???????? ?.?. ????? ??????????????? ?
???????? ??????? ??? ??????? ?????. ?.-????? ???
???????????? ??????, 2005. ?. 99-100.
10
??????? ????????????, ??? ? ???????, ???????
??????? ????????????? ???? ? ????????????????????
??????????, ??????? ??????????? ??????????
???????????.
11
??????? ?????????? ?? ?????? ???????????? EORTC ?
??????????? ?? ?????????? ???????????
???????????????
?????????? ??????? ? ??????????? ???????????????? (n369) ??????? ??? ??????????? ??????????????? (n362) p
???????????gt1 ? 6,9 9,8 gt0,05
??????????? ?????? ?????? 5,5 4,6 gt0,05
???????? 6,1 5,5 gt0,05
??????????? ????????? 1,4 0,6 gt0,05
????????????? 1,2 2,3 gt0,05
Blom, J.H., van Poppel, H., Marechal, J.M.,
Jacqmin, D., Sylvester, R., Schroder, F.H. et al
Radical nephrectomy with and without lymph node
dissection preliminary results of the EORTC
randomized phase III protocol 30881. EORTC
Genitourinary Group. Eur Urol, 1999,36570.
12

• A.Herrlinger ? ?????. (1984) ????????, ??? ???
  ?????????????????? ??????????? ? ???????????
  ???????????????? ????????????????? ???????????
  ?????????? 0,9, ?????? 2,3 ? ?????? ????????
  ????? ????? ??????????????? ?????? ???
  ??????????????1.
• ????????? ??????????? ???????? ?????????? ???
  ??????? ???? ????? ?? ??????????????
  ?????????????? ?????? ??????????.

1. Herrlinger A, Sigel A, Giedl J. Method of
radical transabdominal tumor nephrectomy with
facultative or systemic lymph node dissection and
results in 381 patients Urologe A. 1984
Sep23(5)267-74.
13

• A.Parker (1935) ?????? ??????????? ?????? ?????
  ?? ?????? ? ????? ?????1.
• ?.?.?????? (2003) ??????? ?????????????????
  ??????????? ?? ?????? ????????? ?????2.

1. Parker A.E. Studies on the main posterior
lymph channels of the abdomen and their
connections with the lymphatics of the
genito-urinary system. Am J Anat. 193556409. 2.
?????? ?.?. ????? ??????????????? ???
????????????????? ???????? ?? ?????? ???? ?????.
????. ????. ???. ????. ?., 2003.
14
?????????? ?????????????? ???????????????
??????????? ????????? ??????????? ??????????
??????????? ???????????? ???????????????.
15

• ????????? N ????????????? TNM ???????? ??????
  ????????? ?????? ???????? ???? ????? ??
  ???????????? ?????, ????????????? ? ???????
  ????1,2.
• ?????????? ?????????? ? ????????? ???????????
  ?????????? ????? ?????? ?????? ? ???????????????
  ??????? ? ??????????? ????????.

1. EAU Guidelines for RCC, 2007. 2. AUA
Guidelines for RCC, 2007.
16

• ???????? ???????????? ????????????? TNM
  ?????????? 2002 ???? ????????? pN ??? ???? ?????
  ????? ???? ?????????? ? ?????? ??????????????? ?
  ?????? 8 ? ????? ????????????? ?????1.
• ?? ?????? ????????????? ???????????? ??????????
  ??????????? ? ????????? ????? ??????????
  ????????? ?? 1 ?? 17 ? ?????? ?????????2.

1. EAU Guidelines for RCC, 2007. 2. ????? ?.?.,
??????? ?.?. ???????? ??????? ????????. ?.
????????, 1996. - ?. 269.
17
??????????? ?????? ????? ???????? ?????????,
?????????? ? ????? ? ?????? ????? ????, ?????????
? ????? ???????????? ??????????? ?????????
??????????? ??????? TNM ??? ???????????
??????????? ????????? N.
18

• C.Terrone ? ?????. (2003) ???????? ?? ???????
  608 ?????????, ??? ??? ???????? ????? ? ????? 13
  ????????????? ????? ???????????? ????????????????
  ?? ????????? ?????????? 21 ? 10, ??????????????
  (plt0,001).

Terrone C., Guercio S., De Luca S., et al. The
number of lymph nodes examined and staging
accuracy in renal cell carcinoma. BJU Int.
2003913740
19
??? ??????????? ????? ????????? ??????????
????????????? ? ???????????? ???????????
??????????.
20

• ?.Peters ? G.Brown (1980) ??????????, ???
  5-?????? ???????????? ? ?????? ?????????? ?
  ???????????? ??????????????? ??? III ?????? ????
  ????? (?? ???????), ?????????? 44 ? 26,
  ?????????????? (plt0,01)1.
• A.Herrlinger ? ?????. (1991) ???????? 66-???
  5-?????? ???????????? ????? ?????????????? ?
  ??????? I-III ???????? ??????????? (?? ???????).
  ????? ?????????, ?? ??????????????
  ???????????????, ????????? ?????????? ?? ????????
  58 (plt0,01)2.

1. Peters P.C., Brown G.L. The role of
lymphadenectomy in the management of renal cell
carcinoma. Urol Clin North Am. 19807705709. 2.
Herrlinger A., Schrott K.M., Schott G., Sigel A.
What are the benefits of extended dissection of
the regional renal lymph nodes in the therapy of
renal cell carcinoma. J. Urol. 199114612241227.

21

• ? ????????????? ??????? ??? ?????????
  ???????????? (1989) ????? 70 ??????? ????? ?????
  ? ??????????? ? ????????????? ????.
• 5-?????? ???????????? ????????? ?????????
  ????????? 19.
• ? ??????? ? ?????????? ???????????? ???????????
  ?????? ?????????? ??? ????? 46.
• ????? ????????? ? ????????????????
  ?????????????? ?????????????? ??? ???????????
  ????????????? 5-?????? ???????????? ?????????
  2,6.

????? ?.?. ???????????, ??????????????? ?
????????????????? ???????? ??? ???? ?????. ????.
????. ??? ????. ?., 1989.
22
???????????? ? ??????????? ?? ?????? ???? ?????
?? ?????????? N ? M
n535
n129
n236
n86
Pantuck A.J., Zisman A., Dorey F., et al. Renal
cell carcinoma with retroperitoneal lymph
nodesrole of lymph node dissection. J Urol.
2003 16920762083.
23
???????????? ??????? ????? ????? ?? ??????? N
??? ?????????? ??????????? ????????????? ?
??????????? ?? ?????????? ???????????????
??????????????? ???????????
??????????????? ?? ???????????
Pantuck A.J., Zisman A., Dorey F., et al. Renal
cell carcinoma with retroperitoneal lymph
nodesrole of lymph node dissection. J Urol.
2003 16920762083.
24
?????????????? ???????? ????????????
????????????? ??????? ??????????????? ??
???????????? ??????? ????? ?????, ? ????????? ???
?????????? ??????????? ?????????????.
25
???????????? EORTC ?? ????????? 30881
772 ??????? ????? ????? c ??????????? ???????
T1-3N0M0
41 ??????? ?????? ?? ????????????
389 ??????? ??????????? ???????????
???????????????
336 ??????? ??????????? ??????????????? ??
?????????
5 ???
???? 17 ????????? ???? ?????? ??? ????????
??????????? ????????????
Blom, J.H., van Poppel, H., Marechal, J.M.,
Jacqmin, D., Sylvester, R., Schroder, F.H. et al
Radical nephrectomy with and without lymph node
dissection preliminary results of the EORTC
randomized phase III protocol 30881. EORTC
Genitourinary Group. Eur Urol, 1999,36570.
26
???????????? ???????????? ??????????????????
???? (EORTC) ??? ? ?? ???????? ????? ??????? ????
??????????? ??????? ??????????? ???????????????
?? ?????????? ???????????? ??????? ????? ?????, ?
????? ? ???, ??? ????????????? ?????? ?? ??????
?????? ????????? ?????????? ?????????????? ?????
??????? ??????? ???????????????.
27
1. ????????????? ??????????????? ??? ??????
???????????? ?????????? ??????????? ? ???, ??
??????????? ???????????????? ????????????? ?
?????????, ??-?? ??????????? ???????????????.
?????????? ?? ????? ??????? ??? ?????
???????????????? ???????????, ??? ? ???????
???????. 2. ???????? ??????????? ?????????????
????? ??? ????????? ??????????????? ????
?????????????, ??? ??? ???????????? 46-???
5-?????? ????????????. 3. ??? ?????????????
????????????? ?????????? ? ????????????? ???? ?
??????????????? ????????????? ??????????????? ??
?????????????, ??? ??? 5-?????? ????????????
????????? ????? ???? 2,6.
28

• 4. ??? ???????? ????? ?? ?????? ???? ????????
  ??????????? ?????????? ??????????, ??? ???, ?????
  ?? ????? ???????? ?? ??????, ??????????? ????????
  ???? ???.
• 5. ??? ??????????????? ???? ????? ???????????????
  ????? ???????? ??????????????, ??? ??? ???
  ????????? ??????? ???????????? ?? 5 ??????? ?
  ???????, ??????? ??????????? ???????????
  ?????????????.
• 6. ????? ???????? ??????????? ??????????
  ???????????, ? ????? ? ???, ??? ????????
  ??????????? ??????? TNM ??????????????? ??
  ????????? ? ?????????? gt 8.

29
7. ??????????????? ????????? ???????? ????????,
?? ??? ???? ?????? ????????? ????? ??????????.
??? ?? ??????????? ??????? ?????- ?
????????????????? ??????????. 8. ???????????????
???????? ?????????? ???????, ?????????? 5-??????
???????????? ?? 18.
30
?????????? ?? ????????!