Abdominal nephrectomy

Transabdominal nephrectomy is used for surgical treatment of nephroblastoma. Wilms tumor is one of the most common retroperitoneal malignant tumors in children, ranking second in children with abdominal malignant tumors. Tumors occur in infants and young children. It is reported that 44% are under 2 years old, and 75.5% are under 5 years old, while 90% of cases are seen before 7 years old, and the ratio of male to female is 1:1. Treatment of diseases: pediatric nephroblastoma nephroblastoma Indication Once the nephroblastoma is diagnosed, surgery should be considered. The European Society of Pediatric Oncology (ISPO) emphasizes preoperative chemotherapy for 4 to 8 weeks for children with nephroblastoma over 6 months without waiting for histopathological results, while NWTS considers kidneys without pathological tissue. Preoperative chemotherapy of cell tumors may affect the tissue classification of the resected specimens, affect the detection rate of the variant cases, and may also misdiagnose certain bilateral nephroblastomas. Therefore, on the basis of histological diagnosis, it is only necessary to perform preoperative chemotherapy on huge tumors to increase the resection rate. In the double nephroblastoma, 50% of the poor prognosis of the tissue structure is only on one side, so if one side of the tumor is huge and the contralateral tumor is small, a large tumor nephrectomy is feasible, and the contralateral side is nephrectomized. When nephroblastoma is combined with other organ metastases, if the general condition can tolerate surgery, it is still necessary to seek tumor nephrectomy, then radiotherapy and chemotherapy. Contraindications The nephroblastoma is widely metastasized, and the sick child develops dyscrasia. At this time, the tumor has reached the advanced stage. If the surgical treatment can not prolong the life of the sick child, it should not be treated surgically. Radiation therapy and chemotherapy should be used at the same time as the supportive therapy. If the tumor is huge and has invaded surrounding vital organs, surgical resection may be dangerous, and surgery should be performed after chemotherapy or radiotherapy. Preoperative preparation Understand the cardiopulmonary function of the sick child before surgery, check whether there is any metastasis, and develop a comprehensive treatment plan. Wilms tumors grow rapidly and are prone to metastasis, so preoperative preparation should not be too long. Intravenous pyelography and CT examination should be performed before surgery to understand the function of the contralateral kidney. Children with anemia or general deterioration can be transfused first, and large tumors can be treated with chemotherapy or radiation. Because of the large tumor, it is difficult to accurately estimate before surgery. The surgical wounds of the tumor are larger, so it is necessary to prepare blood 600~1000ml. If the tumor is too large, open a vein channel before surgery, and if necessary, venous incision. Some people advocate the use of actinomycin D one day before surgery. Surgical procedure 1. Incision, take the upper abdominal transverse incision. 2. After entering the abdominal cavity, the tumor side kidney should be carefully explored to determine the tumor invasion of the surrounding organs, and the scope of the operation is estimated. At the same time, the liver and the contralateral kidney were examined for metastasis, and there were no enlarged lymph nodes around the abdominal aorta. Different methods are used to remove the tumor depending on where the tumor is located. If the tumor is on the right side, the peritoneum of the ascending colon is opened; on the left side, the peritoneum of the descending colon is cut open, and is released along the back of the colon, completely revealing the fat sac around the kidney and its wrapped kidney, and opening the kidney on the inside. In the anterior layer of the fascia, the renal pedicle is exposed, and the renal vein is first ligated to prevent the kidney from being squeezed during the operation, and the tumor cells are accelerated by blood transfer. 3. Bluntly separate the adipose tissue near the renal hilum, separate the renal arteries and veins, and carefully explore the presence or absence of tumor thrombus in the renal vein. For example, if there is no tumor thrombus, two renal pedicle clamps are used to clamp the proximal end of the arteriovenous vein, and the distal end is then clamped with a curved vascular clamp, and then cut between the renal pedicle and the vascular clamp. The arteries and veins are ligated or sutured together with a 4th wire. The ureter should be as far as possible to the distal end and then cut and ligated in the lower position. 4. Continue to dissociate the tumor and determine the relationship between the tumor and surrounding organs and tissues. Properly protect the duodenum (right side), the spleen and the tail of the pancreas (left side). If the tumor is located in the upper pole of the kidney, the adrenal gland should also be removed at the same time. When the tumor and the peritoneal adhesions should be removed. If the tumor is closely adhered to the spleen, pancreatic tail, diaphragm, or colon, and the tumor has been invaded, it should be removed at the same time. If the tumor is inseparable from the abdominal aorta or inferior vena cava and cannot be separated, the most common method is to preserve the integrity of the aorta and large blood vessels, and at least retain a part of the tumor capsule or tumor tissue, and use the silver clip as a marker. Postoperative radiotherapy positioning. At the same time, the renal fascia and renal fat sac should be removed together. After removing the tumor, the residual cavity should be carefully stopped. For example, if there is more bleeding, the cigarette can be drained. 5. Reset the colon, suture the peritoneum, and close the abdomen layer by layer. complication 1. When the tumor is huge, it may cause fatal bleeding due to adhesion or infiltration with the surrounding large blood vessels. 2. Giant nephroblastoma may adhere to important organs around it, and it is easy to damage organs during tumor isolation. Due to the compression of the tumor, the surrounding organs may have been displaced, and should be carefully identified during the operation to prevent accidental injury, such as accidental injury to the duodenum, duodenal fistula may occur after repair and life-threatening. 3. When the intraoperative incision is poorly exposed or the operation is rude or the tumor tissue is extensively necrotic, and the liquefaction will rupture, the tumor may be ruptured and the local dissemination may be aggravated.