(1) Testectomy
For any type of testicular tumor, it is emphasized that the radical testosteropathy is used through the groin pathway.
The method is: the surgery uses the inguinal incision of the groin, reaches the top of the scrotum, is separated from the sperm cable. The sperm cable and blood vessels are cut off in the inside of the groin, and the testicles and tumors are removed.
Its precautions are: sperm blood vessels and vasters of the sperm and vasters as much as possible during surgery; sperm cables should be removed as much as possible; preventing tumors from squeezing tumors to avoid proliferation.Simple testicular resection often does not achieve a thorough surgical resection effect. It needs to be performed for post -peritoneal lymph node removal to achieve the purpose of cure.The most widely used incision with the abdomen (from swords to the pubic bone combination).
Its advantages are that the back clearance of the peritoneal can be fully exposed, so that the surgery can be operated under direct vision, and the kidney buttons and the surrounding of the large blood vessels can be fully exposed and thoroughly removed.Its scope includes all lymph nodes, fat and connective tissues in 2/3 of the lower side of the same side.Roy et al. Pointed out that there is a certain difference in the range of testicular drainage on the left and right sides, and there are many traffic branches on the left side of the right side. Therefore, the scope of cleaning should be different. The right side of the cleaning range is larger than the left.Right: It should be started from 2 cm plane above the renal, along the lower cavity vein to the abdominal aorta fork, remove all fat, connective tissue and lymphatic tissue, and also remove lymph nodes between the aortic and lower cavity veins.And the lymph nodes before the aortic aorta, then remove the skeleton lymph nodes to the right and downward from the abdominal aorta fork, and then combine it with the inner ring sperm ligation to remove the residual end.Left: 2cm down the upper abdomen of the abdominal aorta, 2cm down to an anatomy until the abdominal aorta fork, remove all fat, tissue tissue and lymphatic tissue, and also remove the lymph nodes between the aortic and lower cavity veins.Then anatomy to the left and down the skeletal blood vessels from the abdominal aorta fork, remove the lymph nodes of the lymph nodes on the left inner ring, and remove the sperm ligation end.
Some scholars believe that the above -mentioned cleaning method cannot be thorough, and 25%of lymph nodes remain behind the large blood vessels, so the enlarged bilateral peritoneal lymph nodes are used.The method is basically the same as the aforementioned method. Starting from the inside of the ureter on both sides, ligating the waist movement and veins on both sides, so that the abdominal aortic and lower cavity veins are completely free.Lymph nodes and fat tissues are all removed to achieve the purpose of completely removing.The rear metastases of testicular tumor peritoneal are mainly located between the kidney around the level of the root level of the intestinal arterial root and the range of the large vascular split level. A thorough removal of the area is the key to improving the efficacy of surgery.As for whether the rear of the large blood vessel needs to be removed, the opinions are inconsistent.
(2) Lymphoptilization and removal of post -peritoneal lymph nodes
Because non -sperm -primary reproductive cell tumors such as embryooma and teratoma are not sensitive to radiation, after testicular removal, peritoneal lymph nodes should be performed, and the opportunity to cure in phases Ⅰ and Ⅱ can obtain healing.
There are many methods of surgery, and different methods have advantages and disadvantages. At present, most scholars advocate adopting peritoneal repercape lymph nodes from the peritoneum from the sword craft to the pubic incision of the pubic bone.The scope of resection includes 2cm and kidney ethics from the upper boundary to the bilateral renal ethical, the anorexia of the abdominal aorta and the inferior veins of the lower cavity to the iliac blood vessel cross and the upper part of the iliac blood vessels on the same side.All lymph nodes, fats and nodular tissues in the ingots of the ingredients around the same side.
The timing and operation of the abdominal lymph node removal is generally believed that: ① surgery time, while testicular scratching or two weeks later.② Clear lymph nodes in the order of anatomy and strive for a whole block.③ The lymphatic of the lymph in the large blood vessels of the peritoneum should be cautious and light, so as not to damage the large blood vessels, and should not excessively pull the kidney pedicle blood vessels.④ If chemotherapy is required after surgery, it should be performed after two weeks.
(3) Estimulation of isolation in the lungs
For patients with lung metastases, after observation and chemotherapy to inhibit lung lesions, no new lesions can consider surgical resection to fight for cure.
(Editor in charge: zero -degree warm)
