cytoreduction surgery

Tumor cytoreductive surgery is a common surgical method for treating ovarian tumors. Ovarian cancer is one of the most common malignancies in gynecology. Tumor cytoreductive surgery refers to surgical procedures for the purpose of maximally excising tumors in patients with advanced ovarian cancer, which can effectively prolong the survival of patients. Treatment of diseases: pelvic inflammatory mass ovarian cancer Indication Tumor cytoreductive surgery is the standard procedure for patients with stage II, III or IV. For advanced patients who are not suitable for surgery, advanced chemotherapy can be performed, followed by intermediate tumor cytoreductive surgery, but pathological confirmation must be performed before chemotherapy. The following conditions are reasonable choices for re-tumor cytoreductive surgery: 1 after completion of first-line chemotherapy, > more than 12 months of recurrence; 2 residual tumor or recurrent lesions may have complete resection; 3 have a good response to previous chemotherapy 4 good living status score; 5 patients with younger age under the above circumstances, less complication of tumor cytoreductive surgery, can achieve the desired therapeutic goals, beneficial to patients. Contraindications If the following conditions are found during surgery, tumor cytoreductive surgery should not be repeated: 1 large metastases in the liver parenchyma; 2 large lesions in the hilar site; 3 large lymph nodes in the aorta adjacent to the renal vein; 4 multiple metastases in the root and surrounding of the small mesentery, the entire small intestine contracted into a "twist" shape; 5 large pieces of transverse metastasis (> 5cm). There are many complications of re-tumor cytoreductive surgery under the above circumstances, and there is no benefit to the patient. Preoperative preparation If pleural effusion is found, it should be treated before surgery. More than before surgery, puncture and release of water, more time should be placed in the closed thoracic drainage or indwelling thoracic puncture tube, and venting as much as possible before surgery, at the same time, lung function tests and anesthesiology consultation. If the pleural effusion is less, and the unilateral side, the lung function is normal, you can ask for the consent of the anesthesiologist and temporarily do not put the pleural effusion. If the gastrointestinal metastasis is highly suspected or the gastrointestinal tumor cannot be excluded, a comprehensive gastrointestinal examination should be performed before surgery, including barium meal, barium enema, gastroscope and fiberoptic colonoscopy to understand whether the digestive tract is involved, and the location and extent of involvement. Renal blood flow chart examination to understand the basic state of renal function, and can provide a reference for postoperative chemotherapy. Surgical procedure (1) Exploration (Exploration) Exploring should pay attention to the following contents: Incision The incision should be in the median or left lateral median incision and should be large enough (adjusted depending on where the tumor is removed). After basically opening, you can see the stomach, because after retracting with the retractor, or after using the hook, you can see all the organs in the abdominal cavity, the surface of the peritoneum can be seen, but also touched, this mouth is only It is reasonable. 2. Release water If the amount of ascites is relatively large, it should be placed in a batch before surgery. It is best to have too much ascites on the day of surgery. If there is no good water release before surgery, then the intraoperative renal colloid osmotic pressure is very important, and the sudden release of such a large amount of ascites will cause instability of the circulation. Coupled with more bleeding during surgery, this surgery is often not ideal, because the blood pressure is desperately corrected, and it is not possible to remove the tumor normally. Water should be paid attention to speed. 3. Tumors and organs should be observed and palpated, as well as the extent and extent of tumor involvement, and further surgery should be evaluated. (two) omentectomy (Omentectomy) Usually the first step in performing cytoreductive surgery is to remove the omentum. So after opening the stomach, after the exploration, pull out the omentum. If the omentum is stuck to the surrounding area, the adhesions should be separated first. The method of excising the omentum is divided into the following cases: (1) When the omentum is not heavy, the omentum is pulled upward and enters the gap between the omentum and the transverse colon; (2) when the involvement is heavier, it cannot be judged. When the omentum and the transverse colon are in the gap, the resection can be started from the large curvature of the stomach; (3) when the omentum is extremely severely affected, so that the omentum is obviously collapsed, the omentum cake can be opened from the middle of the omentum, along The surface of the intestine extends to both sides to remove the omentum. If the omentum is largely or completely replaced by a tumor, the focus should be on removing the omentum, which is the most important part of the operation, that is, the tumor cell is depleted, which is also the significance of surgery. (C) Resection of pelvic tumor For the removal of pelvic tumors, it is necessary to separate the adhesion of any intestines from the pelvic organs, and to lay the intestines (overwhelming). The automatic retractor should be used, and the chest retractor is easy to use. The uterus can be lifted with a pair of claws or two straight Kocher tongs. There are basically two ways to remove pelvic tumors. One is that when the pelvic peritoneum is not heavily involved, only the whole uterus can be removed (ie, tumor resection), which is our routine method. There are several ways in which this approach enters the retroperitoneal route (ie, the path from which surgery begins), the lateral peritoneum, the round ligament, and the pelvic funnel ligament. complication Pelvic adhesions.

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