Renal wedge resection for renal tumors

The surgery for kidney tumor retention nephron is adapted to 1 isolated kidney. 2 side of the kidney cancer and the contralateral kidney has no function or has been removed, or the contralateral kidney has diseases that may threaten its function such as stones, inflammation and congenital diseases, renal arteriosclerosis and the like. 3 bilateral renal cell carcinoma, the smaller side of the tumor was partially resected, and the larger side was treated with radical nephrectomy. Bilateral single renal tumors were all <3 cm in diameter, and bilateral bilateral partial resection was feasible. 4 unilateral single malignant renal tumor, diameter <3cm, the position is relatively shallow, and the contralateral renal function is normal. Among them, 1 to 3 is called impulsive partial nephrectomy, and 4 is called selective partial nephrectomy. Treatment of diseases: kidney tumors Indication Renal tumor renal wedge resection is suitable for marginal tumors close to the middle segment of the kidney. Preoperative preparation 1. Except for very superficial tumors, renal angiography should be performed before surgery to understand the movement of the renal artery. 2. Understand the condition of the contralateral kidney. 3. Large tumors in the middle of the kidney, where the position is deeper, the pyelography is used to understand the distribution of the renal pelvic drainage system. 4. Prepare sterile crushed ice before surgery. 5. Give enough fluid before surgery to ensure effective intraoperative renal perfusion. Surgical procedure 1. The incision selects the lumbar extraperitoneal incision through the 11th intercostal space or the 12th rib bed. The surgical field is superficial and the renal blood vessels are well exposed. For tumors with a relatively large kidney, the 10th and 9th ribs can be cut at the same time. Bilateral renal partial resection can be used under the bilateral intercostal incision through the abdominal cavity. 2. The kidney is fully freed in the perirenal fascia, and the perirenal fat around the renal tumor should be retained. The adipose tissue around the renal artery, vein and renal pelvis was removed, and the renal artery, vein and renal pelvis were separated. 3. Block the renal artery, the surface is covered with crushed ice for 10 to 15 minutes, and the temperature of the renal parenchyma is lowered to 15 to 20 °C. The renal vein is generally kept open. 4. The renal capsule annular incision was made about 1 cm away from the edge of the tumor, and the renal parenchyma of the tumor margin was bluntly separated. The cord tissue was first cut with a vascular clamp and then ligated with an absorbable line. If the incision enters the renal sinus, it should be pushed away from the renal sinus tissue to avoid damage. 5. Some people have independent renal sputum in the middle of the drainage, and most of the renal pelvis of the middle kidney depends on the upper or lower sputum or both. If the incision enters the renal collecting system, the removal of the middle kidney requires very careful retention of sufficient renal pelvis to drain the upper and lower poles. 6. The vascular end of the renal wound was sutured with a 4-0 absorbable line and the kidney collection system was closed with a 4-0 absorbable line. Open the kidney pedicle, the kidney wound completely hemostasis. The incision wounds can be directly aligned and sutured with 2-0 absorbable lines. If there is tension, it can be filled with perirenal fat or pedicled omentum to the base of the wound, and then fixed to the renal capsule by a 2-0 absorbable line. 7. Fix the kidney, place the perforated pericardial drainage tube, and remove it 4 to 5 days after operation. Renal collection system resection is more extensive, should be placed in the stent tube drainage. complication 1. Bleeding is generally a hemorrhage of the kidney wound. A small amount of bleeding can be strictly bedless non-surgical treatment, monitoring vital signs and supplementing blood volume. Severe bleeding requires surgical exploration. 2. As long as there is no obstruction of the combined system, urinary fistula can generally heal itself and rarely require reoperation. Keep the drainage smooth, if necessary, through the endoscopic stent or percutaneous renal puncture drainage. 3. Ureteral obstruction is generally caused by blockage of blood clots in the collecting system, which can be alleviated with the dissolution of blood clots. 4. Renal insufficiency is caused by intraoperative renal ischemia and surgical removal of part of the renal parenchyma. In most cases, the renal parenchyma can be compensated for hyperplasia, and renal function will be further improved. A few may require temporary hemodialysis or even permanent renal failure. 5. Postoperative infections are caused by poor drainage. As long as adequate drainage is ensured, it can generally be controlled.