手辅助腹腔镜手术治疗儿童肾母细胞瘤1例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2025-02-01 DOI:10.1016/j.epsc.2024.102937

Giovanni Torino , Ottavio Adorisio , Agnese Roberti , Tiziana Russo , Francesco Turrà , Giovanni Di Iorio

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引用次数: 0

摘要

手辅助腹腔镜手术（HALS）是一种技术，它使用一种装置，允许外科医生在保持气腹的同时将一只手插入腹部。虽然在患有良性疾病的儿科患者中有一些HALS的报道，但在儿科肿瘤学中没有记录在案的病例。病例介绍：一名13岁女孩，以左侧腹痛为首发症状。腹部超声显示左肾有肿块。腹部磁共振（MRI）和全身计算机断层扫描（CT）证实存在一个10厘米的左肾肿块，没有转移性病变的证据。根据UMBRELLA SIOP-RTSG 2016方案，患者接受术前化疗，之后随访MRI显示肿块大小缩小至7厘米。我们随后进行了手辅助腹腔镜左肾切除术。GelPort®（Applied Medical, Rancho Santa Margarita， CA， USA）通过一个6厘米的Pfannenstiel切口插入。在左上象限和脐处添加两个5-mm和10-mm套管针。术中膈肌见肿瘤浸润，MRI未见。切除部分膈肌，用间断可吸收缝线修复缺损。从门上、门上、门下、主动脉旁和腹主动脉间区取样8个淋巴结。病理检查证实为母细胞为主的肾母细胞瘤，淋巴结阴性，膈浸润阳性。术后过程顺利，患者于术后第三天出院。术后按方案进行化疗。随访41个月无复发。结论手辅助腹腔镜手术对于需要全肾切除术的实体性肾肿瘤是一种安全有效的手术方法，可降低肿瘤溢漏和出血的风险。

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Hand-assisted laparoscopic surgery for Wilms tumor in a child: A case report

Introduction

Hand-assisted laparoscopic surgery (HALS) is a technique that uses a device that allows the surgeon to insert a hand into the abdomen while maintaining the pneumoperitoneum. While there are a few reports of HALS in pediatric patients with benign diseases, there are no documented cases in pediatric oncology.

Case presentation

A 13-year-old girl presented with the onset of left-sided abdominal pain. An abdominal ultrasound (US) revealed a mass in the left kidney. A magnetic resonance (MRI) of the abdomen and a total-body computerized tomography (CT) scan confirmed the presence of a 10-cm left renal mass without evidence of metastatic lesions. Following the UMBRELLA SIOP-RTSG 2016 protocol, the patient underwent preoperative chemotherapy, after which a follow-up MRI showed a reduction in the mass size to 7 cm. We subsequently proceeded with a hand-assisted laparoscopic left nephrectomy. A GelPort® (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted through a 6-cm Pfannenstiel incision. Two additional 5-mm and 10-mm trocars were added in the left upper quadrant and the umbilicus. During the operation, a neoplastic infiltration was seen on the diaphragm, which had not been seen on MRI. A portion of the diaphragm was resected, and the defect was repaired using an interrupted resorbable suture. Eight lymph nodes were sampled from the hilar, supra-hiliar, infra-hiliar, paraaortic, and inter-aortocaval areas. Pathological examination confirmed a blastemal-predominant Wilms tumor, negative lymph nodes, and a positive diaphragmatic infiltrate. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. She received the postoperative chemotherapy regimen indicated by the protocol. At a follow up of 41 months she has no recurrence.

Conclusion

Hand-assisted laparoscopic surgery appears to be a safe and effective approach for the resection of solid renal tumors requiring total nephrectomy, potentially reducing the risk of tumor spillage and bleeding.

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