People have a pair of kidneys weighing 150 grams each, living in the waist, the spine and large blood vessels on both sides, before the abdominal organs, after the muscles and ribs of the lower back, surrounded by three layers of the membrane wrapped, hidden location, the environment is relatively safe. Seemingly comfortable, but actually very tired; think they are strong, but also often appear vulnerable. First of all, the kidneys face the impact of high pressure and high perfusion of blood from the body circulation, and this internal force from the blood is continuous and never-ending. The renal artery is one of the secondary arteries closer to the heart, directly from the aorta at right angles, accepting 20% of the heart’s ejection volume, by the same weight, renal perfusion is 7 times that of the brain, 5 times that of the coronary arteries, the pressure of the large amount of blood, become one of the common target organs involved in hypertension, but people are more concerned about the heart and brain, the actual kidney is damaged earlier, more serious, often aggravated by uremia and heart and brain lesions Process. Human blood is about 4 liters, as a blood filter 125 ml of liquid per minute is filtered out by the kidneys, this initial reeling cellar С beer bajie protection 24 hours to produce this original urine 180 liters, and then by the treatment of renal tubules at all levels, useful components are reabsorbed and used, waste and toxins are discharged from the body, and finally 1500 ml of final urine is produced in 24 hours. To ensure the body’s water, electrolyte, acid-base balance and the stability of the internal environment. Therefore, medicine says: kidney is the center of water and salt metabolism, the function of kidney is self-evident. In addition, the kidney has a powerful endocrine function. Erythropoietin is produced in the kidney and acts on the hematopoietic system to promote the production of red blood cells. The renin-angiotensin-aldosterone system is an important endocrine system for the regulation of water and salt metabolism in the body, and the conversion process of angiotensin II requires enzymes produced by the kidney. The synthesis of vitamin D in the body cannot be achieved without the help of an enzyme in the kidney, in addition to the skin. Therefore, the kidney does not only produce urine, more functions of the human body need the kidney to complete, not only that, there are many physiological and biochemical processes with the participation of the kidney, which is very thorough in dialysis patients, and the most advanced dialysis machine in the world cannot replace a healthy living kidney. The kidney’s life is not only busy but also full of misfortunes. Congenital structural abnormalities since birth are most common in the kidney, such as polycystic kidney, duplicated kidney, pelvic ureteral junction stenosis and abnormalities of blood vessels. By adolescence immune damage often comes to harass, some causing permanent damage, such as various glomerulonephritis. Connective tissue diseases often occur in young and middle-aged people, such as allergic thrombocytopenic purpura, systemic lupus erythematosus, dry syndrome, and leukoaraiosis, and none of the kidneys are spared. With the change of diet and lifestyle habits kidney stones can occur at any age and can cause secondary damage to the kidney or even loss of kidney function, despite not being a renal lesion. Cystic degeneration and carcinoma creep up again after old age. As benign lesions renal cysts generally have no significant effect on renal function, if they are large they can be de-topped by retroperitoneoscopy, generally less than 5.0 cm need not be treated and can be observed. Kidney lesions are generally more insidious, often to late party discovery, many uremic patients do not have special signs before the diagnosis of uremia. The noble quality and dedication of kidney is reflected by working with disease. Kidney cancer, as the most serious destructive lesion of kidney, is only detected when the cancerous tissue increases to a certain volume, abdominal mass, pain, or destruction to a certain extent, when there is hematuria in the naked eye, which is often at an advanced stage, and with the enhancement of people’s health care awareness, regular medical checkups have become fashionable. Ultrasound and CT can detect kidney cancer below 1.0cm. In the past two months, we have admitted 6 cases of asymptomatic kidney cancer with diameters of 2~6.5cm, all of them are limited kidney cancer, among which 2 cases underwent partial nephrectomy with preservation of kidney units and 4 cases underwent retroperitoneal laparoscopic resection, and all of them have been satisfactorily discharged from the hospital. At present, because there is still no breakthrough in medical research on cancer, especially in the middle and late stage lesions, it is the cause of people’s great fear of cancer, and mental breakdown often leads to the deterioration of cancer and accelerates disease progression. In fact, each type of cancer has both common behavior of cancer tissue and different biological characteristics. There are many kinds of kidney cancer, among which more than 90% are clear cell carcinoma, which comes from renal tubular epithelial cells, characterized by swelling growth, located in one side of kidney, occurring singly, generally less than 7.0cm, often separated from surrounding kidney tissues by pseudo envelope, and the current statistics report that the 5-year survival rate after surgery is more than 70%, which shows that kidney cancer is a malignant tumor with relatively good prognosis. Surgical methods: radical nephrectomy, preserved nephrectomy (partial nephrectomy, wedge resection or enucleation), laparoscopic surgery. Especially small kidney cancer less than 3.0cm undergoes nephrectomy with preserved renal unit and total nephrectomy has the same long-term recurrence rate. Despite the difficulty of surgery, it is of profound significance to preserve renal function to the maximum extent after surgery, the fundamental purpose of treatment is to protect, preserve or restore organ function, the surgery is very thorough and beautiful, but if renal insufficiency or even uremia occurs after surgery, then the surgery loses its value. Although people have two kidneys, sometimes they are fragile and inflammatory diseases often lead to the loss of function of both kidneys at the same time. Faced with the complexity and busyness of kidney function, when one is removed, whether the other one agrees and can bear the entire burden is the primary consideration of the surgeon, which is why preservation is more difficult to determine than resection. In the decision of kidney preservation and resection as well as radical resection, doctors should take science, evidence-based and truth-seeking as the fundamental, and should not over-treat. For the current problem of over-treatment of cancer, there are both the reasons of patients and their families as well as the factors of doctors. Expanded and re-extended radical treatment for cancer is a thing of the past and is no longer advocated. It is the direction of development to formulate appropriate plans from clinical staging and grading as well as patient’s quality of life, prognosis and life expectancy, and individualization of treatment. In the above 2 cases of kidney unit preservation surgery, one was elderly and one had lesions in the contralateral kidney, so kidney preservation surgery was chosen. For surgery kidney preservation is more difficult than kidney excision. For huge kidney cancer, we adopt embolization via intervention first to make the kidney and cancerous tissue necrotic before resection to improve the success rate and increase the safety. Our hospital has operated on 5 cases.
Three cases have survived for more than 5 years after surgery. Metastasis does not mark the end of life, but often the metastasis disappears after the primary cancer is removed, and with the current targeted therapy, it is possible to extend the life of advanced patients. Therefore, kidney cancer is not scary, what is scary is the loss of will. To care for kidney is to cherish life, pessimism and disappointment in the face of disease will lose life, and excessive treatment is a trampling on life. Facing kidney cancer with scientific, realistic and positive attitude and taking individualized treatment is the right choice.