Transthoracic combined nephrectomy

Transthoracic and abdominal combined nephrectomy for the 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: nephroblastoma Indication Once the nephroblastoma is diagnosed, surgery should be considered. European ISPO emphasizes preoperative chemotherapy for 4 to 8 weeks for children with nephroblastoma older than 6 months, without having to wait for histopathological results, while NWTS believes that preoperative chemotherapy for nephroblastoma confirmed by pathological sections does not affect Excision of the tissue classification of the specimen, affecting the detection rate of the variant cases, can also misdiagnose some bilateral nephroblastoma. Therefore, on the basis of histological diagnosis, it is only necessary to perform preoperative chemotherapy on huge tumors to increase the resection rate. 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 1. Understand the cardiopulmonary function of the sick child before surgery, check whether there is any metastasis, and formulate a comprehensive treatment plan. Wilms tumors grow rapidly and are prone to metastasis, so preoperative preparation should not be too long. 2, intravenous pyelography and CT examination should be done 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: first make the 11th intercostal oblique incision to the abdomen, the lower end is 2cm inside the anterior superior iliac spine, then the upper end of the incision is extended upward, and the intercostal muscle and pleura are cut into the thoracic cavity. Cut the corresponding diaphragm as needed. 2. Free kidney and kidney pedicle, the same method as abdominal incision. 3. After the tumor kidney was removed, the diaphragmatic rupture was sutured intermittently with a 4th wire. Place the closed thoracic drainage tube before closing the chest. The kidney bed is placed with a cigarette and drained from the incision or another puncture. The chest and abdomen incisions were sutured in layers 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 abdominal oblique incision operation, the upper end of the incision may damage the pleura, resulting in pneumothorax. 4. 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.