retroperitoneal tumor resection

The retroperitoneal tumor mainly comes from the fat in the retroperitoneal space, loose connective tissue, fascia, muscle, blood vessels, nerves, lymphoid tissues and residual embryonic tissues, etc., excluding the organs in the retroperitoneal space (most of the duodenum) Tumors of the pancreas, adrenal glands, and ureters. Retroperitoneal tumors are not uncommon, and there are two major categories of benign and malignant. Malignant tumors account for about 60% to 80%, among which are fat sarcoma, fibrosarcoma, leiomyosarcoma, neurofibrosarcoma and malignant lymphoma, etc., rare malignant fibrous histiocytoma, yellow granuloma, etc. . Among benign tumors, fibroids, neurofibromas, teratomas, etc. are common. In general, in retroperitoneal tumors, cystic people are often benign, and most of them are malignant. Post-peritoneal tumors are often diagnosed at a later stage because of no obvious symptoms. Many patients have invaded adjacent organs or important blood vessels at the time of treatment. Common symptoms include abdominal distension, abdominal pain, low back pain and leg pain. Anorexia and fever are more common in cases of extensive infiltration of tumors. Modern application of B-ultrasound, CT and magnetic resonance imaging (MRI), angiography, etc. for the shape and size of retroperitoneal tumors and their relationship with some nearby tissues and organs are relatively clear, so the qualitative, determinate and identification of tumors Diagnosis is a big help. The final diagnosis depends on the exploratory laparotomy and pathological examination. Surgical resection is the main treatment for this disease. The concept of total resection of retroperitoneal tumors is the complete removal of the naked eye of the tumor mass. Extensive resection of the retroperitoneal tumor refers to the removal of the organ or tissue that is intimately separated from the peritoneal tumor while excising the retroperitoneal tumor. Benign tumors should be removed as much as possible. If the tumor is large and cannot be completely removed, an intracapsular resection may also be considered to relieve the compression of the gastrointestinal tract, urinary tract or blood vessels and nerves. Malignant tumors should be extensively resected if there is no distant metastasis, but it should not be forcibly removed to avoid extensive oozing or hemorrhage that is difficult to control during surgery, which is life-threatening. Treatment of diseases: retroperitoneal tumors Indication 1. If the tumor is diagnosed as a retroperitoneal tumor and the tumor is not too large, the base is not wide, and it is not fixed, it can be surgically explored. 2. The first time to explore a tumor that has not been resected, such as radiotherapy or chemotherapy after exploration, the tumor is significantly reduced and it is estimated that there may be resection, you can re-exploration. 3. Recurrence of retroperitoneal tumor after surgical resection, if it can still move without contraindications, it can also seek secondary surgical resection. Contraindications 1. Older, weaker, unable to tolerate surgery. 2. Those with heart, lung disease and severe dysfunction. 3. The distant part is determined to have a tumor metastasis. 4. There is a large amount of bloody ascites. 5. The tumor is huge and the adhesion is fixed. Preoperative preparation 1. According to the size and nature of the tumor and its relationship with large blood vessels, prepare enough blood (usually 2000-3000ml). 2. For intravenous pyelography, to understand bilateral renal function and ureteral displacement. Because sometimes it is necessary to combine the removal of one kidney. 3. Selective angiography before surgery can understand the blood supply of the tumor, and can be embolized to make the tumor shrink and then undergo surgery. Magnetic resonance angiography (MRI) or arterial digital subtraction angiography (IA-DSA) can be used to understand tumor vascular conditions and estimate the anatomical location of large tumor vessels in order to control these vessels intraoperatively and reduce bleeding. 4. Prepare the bowel before the operation of the large intestine. Can be used for gentamicin, metronidazole and other drugs. 5. Vascular preparation includes preparation of vascular surgical instruments and artificial blood vessels for repair or transplantation when important blood vessels are involved or damaged. 6. Fasting before surgery, place the stomach tube, and parallel gastrointestinal decompression. 7. Apply for intraoperative cryosection examination. Surgical procedure 1. A transabdominal, transthoracic, or oblique oblique incision can be used. For retroperitoneal tumors outside the renal zone, various types of abdominal incisions can be selected depending on the size and location of the tumor. A large retroperitoneal tumor in the upper abdomen, when it is found to be necessary after laparotomy, can be converted into a chest and abdomen joint incision through the intercostal space or a section of the rib. 2. Exploring, separating, and revealing the tumor, and exploring the relationship between the tumor and surrounding tissues, organs, and important blood vessels. During the operation, small pieces of tissue should be taken for cryosection examination to aid diagnosis. 3. Protect large blood vessels from damage. Some large tumors can be punctured with a thick needle after laparotomy. After more fluid (including blood, purulent or urine sample) is taken out, the tumor becomes smaller, which can improve the tumor resection rate and reduce the vascular injury rate. 4. Usually, the adhesion to the tumor is separated from the surrounding area, and then gradually separated from the base, and separated, and the hemostatic is pressed with a gauze pad. When the blood vessel is seen, it should be ligated or sutured one by one. The oozing can spray the noradrenal gland. Adrenergic solution (4-6 mg/100 ml). 5. If there is more bleeding and is difficult to control during the process of tight adhesion between the isolated tumor and the surrounding tissue, it should be considered to remove the affected organ and the tumor without affecting life. 6. In the pelvic retroperitoneal tumor resection, there is more chance of major bleeding, and the preparation of the abdominal aorta or its main branch should be temporarily blocked. 7. If major bleeding occurs during the separation process, it can generally be filled with dry gauze pad to stop bleeding. In the case of rapid blood transfusion and infusion, the surgeon closely cooperates to quickly remove the tumor from the capsule. After the tumor is removed, the tumor bed is filled with a gauze pad. After about 10 minutes, slowly take out the gauze pad, see the bleeding points, sew one by one or repair the torn blood vessels. 8. When the general hemostasis measures are invalid, you can also consider cutting a small number of small holes with a sterile plastic bag, and filling the gauze strips or iodoform gauze strips on the bleeding site. Alternatively, the gelatin sponge may be used to fill the part, and then the gauze strip is filled, and the tail end of the gauze strip is taken from the abdomen. The gauze packing area should be placed with a negative pressure double sleeve to gently attract. The gauze strips were taken out 5 to 7 days after the operation and were taken out after about 10 days. This method of compression hemostasis is often effective for extensive bleeding. 9. After the abdominal wall incision is rinsed clean, layered suture. A cigarette or double cannula drainage is placed in the abdominal cavity.