Text/Yangcheng Evening News all-media reporter Chen Hui intern Zheng Minshan
Correspondent Peng Fuxiang Liang Jiayun
Photo/Courtesy of the hospital
Kidney cysts are a benign disease, and 50% of adults over the age of 50 will find kidney cysts on physical examination, so most people do not agree. The same is true of 40-year-old Ms. Zhang, who found that there was a 6 cm "kidney cyst" two years ago, "big heart" she did not see the doctor in time, the tumor grew to 15 cm, it turned out to be cystic kidney cancer, the mass pressed the renal portal blood vessels, inferior vena cava, intestinal tube, almost did not save the kidney.
Green is for tumors, brown is for kidneys, red is arteries, and blue is veins
Why is the "kidney cyst" so big a disaster?
Professor Luo Junhang of the Department of Urology of the First Affiliated Hospital of Sun Yat-sen University introduced that most of the renal cysts are simple renal cysts, and a small number are complex renal cysts. The former is a spherical, smooth sphere with liquid in the middle; the latter can be seen in the B ultrasound is multi-grid, multi-cystic, the shape is not necessarily regular, and the middle is also liquid. In complex kidney cysts, 10% may be cystic kidney cancer, which is malignant.
Surgery is not necessarily required for benign kidney cysts, and regular observation is sufficient, even if the cyst ruptures and fluid flows out. However, if it is malignant, that is, cystic kidney cancer, surgery is required as soon as possible, otherwise the larger the tumor, the more difficult it is to protect the kidney, and once the ruptured cyst ruptures, the cancer cells contained in the liquid will spread out, increasing the risk of metastasis.
How to pull out the 10% cystic kidney cancer from complex kidney cysts? Professor Luo Junhang suggested that if there is a "complex kidney cyst" in the physical examination report, it is recommended to go to the urology department of the hospital for treatment, ask a specialist doctor to check, and distinguish whether it is cystic kidney cancer by enhancing CT and other means. The protagonist of this article, Ms. Zhang, is because she missed the step of "seeing a specialist" and caused her condition to worsen, and she almost lost her kidneys.
Associate Professor Chen Xu of the Department of Urology of Zhongshan First Hospital introduced that they are conducting research and hope to better identify malignant features in complex kidney cysts through artificial intelligence.
Ignoring the physical examination of the mass, 15 cm kidney cancer grew in 2 years
Ms. Zhang was also scared when the "kidney cyst" grew to 15 centimeters and went to the local hospital for treatment. Further CT found that the kidney cyst that had been mistaken for it was actually cystic kidney cancer, and the huge water sac hid a lumpy tumor inside.
Ms. Zhang consulted a specialist in urology and generally believed that kidney preservation surgery was very difficult and would likely require total renal resection. She learned that Professor Luo Junhang has rich experience in the treatment of complex and huge kidney cancer, and because she could not hang up, Ms. Zhang asked Professor Luo Junhang for help online through the Internet Hospital of Zhongshan First Hospital.
Professor Luo Junhang learned in detail about the patient's condition, judging that Ms. Zhang's tumor has not yet invaded the surrounding tissues and organs or distant metastasis, which belongs to T2 stage kidney cancer, according to the current domestic and foreign guidelines, although the operation is difficult, it can still be performed kidney protection surgery, so it is arranged to be admitted to the hospital.
Tumor cutting and kidney protection surgery is unprecedentedly difficult, and robots assist in overcoming difficulties
With rich clinical experience and surgical skills, Professor Luo Junhang's team has successfully performed tumor resection and kidney protection surgery for a number of patients with huge complex kidney cancer, but this time facing a 15-centimeter-large kidney tumor, it is undoubtedly a huge challenge for the doctor team.
Professor Luo Junhang said that first of all, the tumor body is huge, 1.5 times the size of the kidney, compressing the renal portal blood vessels, inferior vena cava, intestinal tube, isolation and exposure is difficult, slightly careless will cause major bleeding or damage to the intestinal tract; secondly, the cystic wall of cystic kidney cancer is as thin as paper, in the process of separation and resection, a little carelessness will cause cyst wall damage, the liquid and tumor cells in the sac flow to adjacent parts, causing postoperative tumor implantation and metastasis; finally, the operation must completely remove the huge tumor, suture the large and deep wound, carry out kidney reconstruction, To prevent postoperative bleeding and urinary leakage, it is also necessary to avoid excessive renal vascular blockade time, resulting in irreversible damage to postoperative renal function. This one difficulty after another requires Professor Luo Junhang's team to overcome the difficulties and overcome them one by one.
Patients present pennants to the treatment team
On the day of the operation, Professor Luo Junhang, with the help of the robot, with the help of the three-dimensional 15x magnification field of vision, clearly identified the tumor boundary and carried out precise separation, avoiding accidental injury to the tumor capsule wall, surrounding organs and blood vessels, and at the same time, finely separating and identifying the renal branch arteries, and blocking the branch arteries that supply the tumor and the branch arteries that supply the normal kidney step by step. On the deep suture of the wound, Professor Luo Junhang first opened the normal kidney supply branch artery and then continued to suture superficially, which controlled the renal ischemia time within 25 minutes, which greatly protected kidney function. After the operation, the patient's renal function was consistent with the preoperative period, there were no complications, and the patient has been successfully discharged from the hospital. (For more news, please pay attention to Yangcheng Pie pai.ycwb.com)
Source | Yangcheng Evening News Yangcheng Pie
Editor-in-charge | Wang Moyi