OBJECTIVE:To report the results of laparoscopic nephrectomy for unilateral Wilms' tumour in children treated with chemotherapy before surgery. PATIENTS AND METHODS:Eight children with unilateral nonmetastatic Wilms' tumour included in the International Society of Pediatric Oncology 2001 protocol were treated with vincristine/actinomycin D and then had laparoscopic nephrectomy and lymph-node sampling. A Veress needle puncture was made and a four-trocar transperitoneal approach was used in all cases. The tumour was extracted with no morcellation through a Pfannenstiel incision. RESULTS:All eight tumours were completely removed, with lymph node samples; intraoperative bleeding was minimal (50 mL). There were no complications after surgery and patients were discharged after 2-3 days. No recurrences of disease, port-site implantation or long-term complications were detected. CONCLUSIONS:Laparoscopic nephrectomy for unilateral Wilms' tumour is feasible in children after chemotherapy; it is safe and allows the complete surgical approach required for treating this tumour. Although the patients had a good long-term follow-up, more patients are needed to compare the results of laparoscopic techniques with open surgery.

译文

目的:报道腹腔镜肾切除术治疗儿童化疗前单侧Wilms肿瘤的结果。
患者与方法:将国际儿童肿瘤学会2001年方案中纳入的8例单侧非转移性Wilms肿瘤患儿用长春新碱/放线菌素D治疗,然后进行腹腔镜肾切除术和淋巴结取样。在所有情况下均进行了Veress穿刺,并使用了四针经腹膜入路。通过Pfannenstiel切口在没有粉碎的情况下提取肿瘤。
结果:8例肿瘤全部切除,淋巴结清扫。术中出血极少(50 mL)。手术后无并发症,2-3天后出院。没有发现疾病复发,港口植入或长期并发症。
结论:腹腔镜肾切除术治疗儿童单侧Wilms肿瘤是可行的。它是安全的,并允许治疗该肿瘤所需的完整手术方法。尽管患者长期随访良好,但仍需要更多患者将腹腔镜技术与开放手术的结果进行比较。

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