Nephrectomy for renal tumors

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 nephrectomy is suitable for renal tumors that are confined to the upper and lower poles of the kidney. 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. For tumors with a relatively large kidney, the 10th and 9th ribs can be cut at the same time. Bilateral renal partial resection can be used under the bilateral intercostal incision through the abdominal cavity. 2. The kidney is fully freed in the perirenal fascia, but the perirenal fat around the renal tumor should be retained. If there is an independent superior or inferior renal artery, it is directly blocked, and the renal pole is removed along the ischemic boundary. If this is not the case, follow the steps below. 3. Strip the adipose tissue around the kidneys, veins and renal pelvis, and release the renal artery, vein and renal pelvis. 4. A considerable number of people with suprarenal poles are supplied by independent cusp arteries, which can be found in front of the renal pelvis to block. The inferior part of the kidney may have an independent sub-renal artery, which runs under the anterior and posterior renal pelvis. After the blockage, a clear boundary line of the renal ischemic contour is visible. If the tumor is within the ischemic area, it may not be necessary to block the renal artery trunk. If the renal tumor is beyond the ischemic area, it is generally not recommended to free other branches of the renal artery from the renal hilum. In this case, the renal artery trunk should be blocked first, and 5 to 10 minutes before the renal artery is blocked, 100 to 150 ml of mannitol can be administered intravenously. Local cooling was performed with externally applied kidneys with crushed ice, and surgery was started 10 to 15 minutes later. The renal vein is not blocked, which can reduce the ischemia of the kidney during operation, and the vein section can be found by venous reflux bleeding, which is easy to stop bleeding. 5. The renal capsule was cut at 1 cm from the edge of the tumor, and the renal parenchyma was bluntly separated. The cord tissue was first cut with a vascular clamp and then ligated with an absorbable line to cross the kidney and remove part of the renal pole assembly system. Renal pyelography, which is close to the middle segment of the kidney, requires renal angiography before surgery to understand the movement of the posterior segment of the kidney. Some of the posterior renal artery trunks are close to the back of the renal pelvis and are curved downwards in the kidneys (Fig. 7.2.2.1-4). In this case, when the parenchyma of the posterior segment of the kidney is transected, the stroke of the posterior segment of the artery should be found and its branches should be freed. If the vessel of the upper pole of the kidney is blindly removed, a large piece of necrosis of the renal parenchyma can be caused. 6. The vascular end of the renal wound was sutured with a 4-0 absorbable line and the kidney collection system was closed with a 4-0 absorbable line. Open the kidney pedicle and ligature the bleeding point. The bleeding on the wound surface can be stopped by hemostasis. If there is still oozing blood, the kidney section can be electrocoagulated to stop bleeding. The wound was covered with perirenal fat or free peritoneum or pedicled omentum, and then the renal edge was sutured intermittently with a 2-0 absorbable line, and the tissue was slightly tensioned to cover the tissue to achieve further hemostasis. 7. Fix the kidney, place the perforated pericardial drainage tube, and remove it 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.

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