Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 3
Böbrek tümörlerinin cerrahi tedavisi sırasında görülen intraopereatif organ yaralanmaları
- Sayfa
- 324–328
- DOI
- —
Özet
Böbrek hücreli kanser (BHK) böbreğin en sık görülen malin hastalığıdır ve standart tedavisi cerrahidir. Bu çalışmanın amacı, böbrek kitlelerinin cerrahi tedavisi sırasında karşılaştığımız intraoperatif organ yaralanmalarını retrospektif olarak değerlendirmektir. Böbrek tümörü ön tanısı ile cerrahi tedavi yapılmış 108 (73 erkek, 35 kadın) olgunun dosyaları retrospektif olarak değerlendirilerek, intraoperatrif organ yaralanmaları incelenmiştir. Olguların ortanca yaşları 58 (min 20, maks 82)'dir ve 101'ine radikal nefrektomi (RN), 7'sine nefron koruyucu cerrahi (NKC) yapılmıştır. Cerrahi girişimler sırasında 22 olguda (%20.4) çeşitli organ yaralanmaları olmuştur. Bu olguların 20'sine RN, 2'sine NKC uygulanmıştır. En sık karaciğer ve dalak ile ilgili organ yaralanmaları görülmüştür. Bu hastaların 12'sinde (%54.5) tümör sağda, 10'unda (%45.5) sol böbrekte yerleşmekteydi ve ortalama tümör boyutu da 6.8 cm idi. Organ yaralanması olan olgulardan sağ böbreğinde tümör olanların ortalama tümör boyutu 7.6 cm, sol böbreğinde tümör olanların ise ortalama tümör boyutu ise 5.8 cm idi. (p=0.22). Organ yaralanması olanlar ile, olmayanlar arasında tümörün boyutu ve lateralitesi yönüyle ilişki saptanmadı (sırasıyla p=0.30, p=0.38). Böbrek tümörlerinin cerrahi tedavisi sırasında uygulanan cerrahi tekniğe, tümörün özelliklerine ve cerraha bağlı olarak çeşitli organ yaralanmaları gelişebilmektedir. Planlı, uygun, dikkatli bir cerrahi teknik ve erken tanı ve onarım ile intraoperatif organ yaralanmaları en aza indirilebilir.
Abstract
Introduction: Renal cell carcinoma (RCC) is the most common malignancy of the kidney and radical nephrectomy (RN) or nephron sparing surgery (NSS) has been the standard treatment. Due to the technological developments and the increasing use of the imaging modalities like abdominal ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), increasing numbers of RCCs have been diagnosed in recent years. Therefore, the number of surgical treatments has also increased. Intraoperative organ injuries during RN and NSS could occur during surgery. The aim of this retrospective study was to evaluate the intraoperative organ injuries occurred during the surgical management of kidney tumors. Materials and Methods: The data of 108 (73 male, 35 female) consecutive patients with the diagnosis of kidney tumor who were treated at our institution were reviewed retrospectively. One hundred and one patients underwent RN and 7 underwent NSS. Preoperative staging included physical examination, hemogram and biochemistry, abdominal US, chest x-ray, intravenous urography, abdominal CT and abdominal MRI. Radical nephrectomy was the standard treatment of choice in patients with kidney tumors. NSS was performed for the tumors with a peripheric location and smaller than 4 cm. Other indications for NSS were having a single tumor bearing kidney, bilateral renal kidney tumors, renal insufficieny, having nephrolithiasis in the opposite kidney or von Hippel-Lindau disease. Results: Of the 108 patients, 101 had RN and 7 had NSS. Median age of the patients was 58 (range, 20-82) years. Organ injuries were detected in 22 (20.4%) patients. The most frequent intraoperative organ injuries were liver and spleen injuries. Twenty of the patients who underwent RN (%19.8) and 2 (%28.5) of the patients who underwent NSS had organ injuries. Of the patients with intraoperative organ injuries 12 (54.5%) had right sided and 10 (45.5%) had left sided kidney tumors. The mean tumor size was similar (6.8 cm) in patients with and without organ injuries and no significant correlation was detected regarding the tumour size and laterality (p=0.30 and p=0.38, respectively). Of the patients with organ injuries, tumor size was 7.6 cm in the right sided tumors and 5.8 cm in left sided ones (p=0.22). Out of 22 patients with organ injuries, transperitoneal anterior subcostal (Chevron) incision was performed in 17 patients and flank incision was performed in 5 patients. Of the 4 patients with pleural injury, 3 had flank incision and 1 had Chevron incision. Four vascular and 7 liver injuries were occurred in patients who had undergone surgery with Chevron incision. Conclusion: A variety of organ injuries can occur during the surgical management of kidney tumors. These injuries could be due to the surgeon, the surgical technique and the features of the tumor. Intraoperative organ injuries can be minimized by using a well planned and careful surgical technique as well as early diagnosis and repair of these injuries.