Kidney tumor extraction

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 extraction is suitable for superficial single or multiple, unilateral or bilateral benign tumors of the kidney <2 cm in diameter. Most scholars advocate the use of partial nephrectomy as much as possible, with less eradication, on the grounds that the tumor may invade the blood vessels outside the pseudo-envelope. 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. Bilateral renal partial resection can be used under the bilateral intercostal incision through the abdominal cavity. 2. Free kidney in the perirenal fascia, retaining the perirenal fat around the kidney tumor. Free kidney pedicles to block the renal pedicle if necessary. 3. The renal capsule is cut around the renal tumor, and the pseudo-envelope formed by the compression of the renal tissue is bluntly separated by a shank or a meningeal stripper to remove the tumor. If it is not easy to peel off, it is better to remove the renal parenchyma. The wound was soaked in distilled water for 5 minutes, and the specimen was sent to a frozen biopsy. If there is still tumor infiltration at the edge, the scope of surgery should be expanded. 4. The vascular end of the renal wound is sutured with a 4-0 absorbable line. The wound can be oozing with gauze to stop bleeding, or the argon gas knife can be used to electrocoagulate the kidney. Carefully examine the renal collection system and the injured renal pelvis should be sutured. The periosteal fat or pedicled omentum was used to fill the base of the wound, and then fixed to the renal capsule by a 2-0 absorbable line. 5. Place the perforated pericardial drainage tube, and remove it according to the drainage volume from 4 to 5 days after operation. 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.