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Abstract: Ms. Zhao described herself as having a normal life, no back pain, hypertension, diabetes and other underlying diseases, and was found to have a right kidney tumor by ultrasound examination of the urinary system during the unit physical examination. Enhanced CT examination of the kidney suggested that the right kidney tumor was significantly enhanced and was considered to be kidney cancer. After repeated consideration, he was treated with laparoscopic partial nephrectomy. Up to now, Ms. Zhao has been followed up for 6 years, with good recovery, normal biochemical indexes and no recurrence or metastasis.
Basic information】Female, 34 years old
Disease Type】Stage I renal cancer
Hospital】Harbin First Hospital
Time of consultation】June 2015
Treatment plan】Surgical treatment (laparoscopic partial nephrectomy)
Treatment period】7 days of hospitalization, 6 years of postoperative follow-up
Treatment effect】Good recovery, normal biochemical index, no recurrence and metastasis
I. Initial consultation
In June 2015, during a physical examination, the physician told her that a mass on the right side of the kidney, about 3.5 cm in size, was considered to be a kidney tumor, the benignity and malignancy of which were unclear for the time being. After discussing with her family, she took leave and came to my hospital.
On examination after admission: no mass in the abdomen, no mass in the kidney area, and negative percussion pain in the kidney area. Enhanced CT examination of kidney suggested: right kidney tumor, tumor located in the lower level of right kidney, size about 3.5cm×2.8cm, tumor enhanced significantly, considered to be kidney cancer, no enlarged lymph nodes, no renal vein tumor embolism.
(Renal enhancement CT)
II. Treatment history
We told Ms. Zhao and her family in detail about the disease of kidney cancer, the incidence of which occupies 2%-3% of adult malignant tumors. The cause of the disease is still unclear and may be related to genetics, smoking, obesity, hypertension, etc. In terms of pathology, it can be divided into various types, the common one in clinical practice is clear cell carcinoma, and the treatment options are radical nephrectomy and partial nephrectomy, both of which can achieve the treatment purpose. Considering that Ms. Zhao is relatively young, complete removal of the affected kidney will have a greater impact on kidney function and even require long-term dialysis treatment if the contralateral kidney develops disease again in the future. Therefore, partial nephrectomy is recommended, which can preserve most of the normal kidney and is more resistant to future risks. The surgical methods include open surgery and laparoscopic surgery, among which laparoscopic surgery is less traumatic, with quick recovery and short hospitalization time, and the surgical incision is small, which is more suitable for Ms. Zhao’s beauty-loving psychology, and under comprehensive consideration, she decided to adopt laparoscopic partial nephrectomy.
Before the operation, Ms. Zhao was provided with relevant examinations, including blood routine, biochemical full test, infectious disease screening, coagulation function, electrocardiogram, chest X-ray and abdominal CT. The operation was performed under general anesthesia. During the operation, the kidney tumor was gradually and completely removed and the wound was sutured through three operation holes of about 1 cm in diameter, using ultrasonic knife, separating forceps and other instruments.
III. Treatment effect
18 hours after the operation, Ms. Zhao could ventilate on her own, could eat liquid food, and gradually enhanced her diet, and the drainage flow in the drainage tube was about 50 ml. 2 days after the operation, she moved to the ground on her own without obvious pain, and the drainage flow in the drainage tube was about 5 ml. kidney function was in normal range. The drainage tube was removed 4 days after surgery, and the patient was discharged on the 5th day after surgery. At present, Ms. Zhao has recovered well with normal biochemical indexes and no recurrence or metastasis in the six years of postoperative follow-up.
IV. Notes
We are glad that Ms. Zhao’s symptoms have improved after treatment, but after nephrectomy, we should still remind Ms. Zhao’s family to take good care of her, pay attention to the condition of the tracheal drainage tube, the color and amount of drainage fluid, and ask the doctor to check in time if the drainage flow increases significantly. After the operation, pay attention to bed rest and avoid premature activities to reduce the risk of bleeding from the surgical wound. After resuming feeding after surgery, gradually enhance nutrition to promote wound healing. Although the surgery has removed the tumor, there is still a risk of recurrence and metastasis, and you need to come to the hospital for review on time. It is recommended to come to the hospital for review 4-6 weeks after surgery, focusing on assessing kidney function and postoperative recovery, and then come to the hospital for review every 6 months, and after 5 years, it can be reviewed once every 2 years.
V. Personal insight
Young people should also have regular medical checkups to detect the disease at its early stage and to provide timely treatment, which can lead to a better prognosis. When the disease has already occurred, we should not refrain from treating the disease, but should deal with it in a timely manner and actively cooperate with the doctor. In this case, after Ms. Zhao and her family learned about the disease, they were very frightened psychologically. Talking about cancer is the normal reaction of many people, and since Ms. Zhao is so young, this disease has a huge impact on the whole family. Through our detailed explanation of the disease, Ms. Zhao and her family understood the available treatment options, the advantages and disadvantages of each treatment option, and the expected results that could be achieved, and finally Ms. Zhao and her family chose laparoscopic partial right nephrectomy. After the operation, she came to the hospital for regular review according to the doctor’s requirements.