利用modified Makuuchi切口於巨大後腹腔腫瘤切除之經驗

施孟宏^1、2、楊明昕²、曹志惟²、蒙恩²、查岱龍²、孫光煥²、于大雄²、高建璋²

Experience with modified Makuuchi incision in the surgical treatment for huge retroperitoneal tumor

Meng-Hung Shih^1,2、Chih-Wei Tsao²、Ming-hsin Yang²、En Moon²、Tai-Lung, Cha²、Guang-Huan Sun²、Dah-Shyong Yu²、Chien-chang Kao²

Abstract

Background:

Surgical treatment for removal of huge renal tumor remain a challenged technique for urologist. We describe our experience with the modified Makuuchi incision for huge renal tumor and combine surgery.

Methods:

We applied the modified Makuuchi incision in nine patients who had huge retroperitoneal or renal tumor. A modified Makuuchi incision of the abdomen was begins cephalad to the xiphoid, extends to 1 cm above the umbilicus, and then extends laterally to the lateral flank. Through the incision, we mobilized the colon and retroperitoneal space was seen, the tumor was removed. Due to invasion of the surrounding organ, we also consult general surgery or CVS specialist for removal of tumor. Patients’ age ranged from 43 to 76 years. 3 patients were male, and 4 patients were female. Renal tumors affected the right side in 4 patients and the left side in 3 patients.

Results:

The modified Makuuchi incision successfully provided a good and rapid exposure. No serious complications such as bleeding or other organ injuries happened during the surgery. Blood transfusion during surgery was unnecessary. There was no  post operative complications, such as wound infection, lung atelectasis/pneumonia, or incisional hernia. There were 3 cases combine with other surgical department including cardiovascular and general surgery surgeon. Partial hepatectomy, splenectomy and distal pancreatomy, thrombectomy of IVC thrombus was also performed through the same incision. There was no need of new incision.

Conclusions:

Our experience demonstrated that the modified Makuuchi incision is a good choice in patients with huge renal tumor, especially those with surrounding organ invasion. However, a large, prospective, controlled study comparing different incision types in the same procedure with variables, such as operating time, postoperative pain scores, patient’s satisfaction, and postoperative complication, is needed to support the benefit of the modified Makuuchi incision.