Wilms tumor resection

After the diagnosis of nephroblastoma (wilms tumor), if there is no distant metastasis, thorough surgical resection should be performed. Treatment of diseases: pediatric nephroblastoma nephroblastoma Indication Patients with nephroblastoma (wilms tumor). Preoperative preparation 1. If the tumor is relatively large, short-term (about 2 weeks) radiation and chemical treatment should be performed before surgery. Most cells of nephroblastoma are sensitive to radiation. A huge tumor can be treated with radiotherapy to shrink the tumor and then resection, which is more advantageous. Postoperative radiotherapy can also be used to improve the efficacy. Chemotherapy is preferably vincristine or nascentine. 2. Preoperative enema to clean the intestines. Surgical procedure Take the right side as an example. 1. Position: The supine position, the right side of the waist is slightly higher. 2. Incision: Intra-abdominal incision can also be used, or can be used as an abdomen "-" shaped incision. If a larger incision is required, a pleural incision can be made. 3. Exploring the abdominal cavity: After entering the abdominal cavity, if there is no ascites and metastatic tumors, including the main organs without metastatic lymph nodes, the peritoneum can be cut off the outside of the ascending colon. 4. Isolation of the renal hilum and tumor: push the ascending colon and the mesentery inward until the renal hilum is revealed. Carefully separate the kidneys, veins, and clamp, cut, ligation, and suture. The blood vessels around the tumor are relatively large and need to be ligated one by one. Once they are torn, the amount of bleeding is large. Damage to the inferior vena cava should be avoided. 5. Clear lymph nodes: Cut the lymph nodes around the renal pedicle and the aorta, along with the surrounding adipose tissue and adrenal gland. Care should be taken to avoid damage to the duodenum when treating the posterior aspect of the tumor. 6. Resection of the tumor: The ureter was cut off near the bladder, the stump was swabbed with sulphuric acid, alcohol and saline, and the tumor was completely removed by suture with a thick thread. Carefully check the kidney fossa for bleeding. If there is obvious bleeding point, it should be ligated. The bleeding can be stopped by hot saline gauze. 7. Drainage, suturing: After completely stopping bleeding, put a cigarette in the kidney socket to drain, and lead out from the outside of the incision. Finally, the peritoneum was sutured intermittently with a silk thread to close the abdominal cavity.