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Offene chirurgische Therapie von Nierenparenchymtumoren

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Die Urologie

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Der am häufigsten gewählte Zugangsweg zur Nephrektomie oder Nierenteilresektion ist der retroperitoneale, laterale Zugang mit subkostaler oder suprakostaler Inzision. Technisch erfolgt bei der Nephrektomie nach der Mobilisation der Niere die Darstellung der Nierenstilgefäße und im Anschluss das Absetzen ebendieser. Schlussendlich erfolgt die Bergung des Organs. Eine Lymphadenektomie ist nur bei klinisch fortgeschrittenen Tumoren sinnvoll. Eine ipsilaterale Adrenalektomie ist nur dann notwendig, wenn die Nebenniere in der präoperativen Bildgebung tumorinfiltriert erscheint. Ein fortgeschrittener Nierentumor mit Beteiligung der Vena cava wird bei 4–10 % der Patienten mit Nierenzellkarzinomen beobachtet. Während Tumoren mit niedrigem Level (I nach Staehler) wie eine Nephrektomie therapiert werden, ist für fortgeschrittene Tumoren (Level III nach Staehler) ein interdisziplinäres Setting, häufig unter Zuhilfenahme eines extrakorporalen Kreislaufs notwendig. Eine nierenerhaltende Tumorchirurgie sollte aktuell immer dann angewandt werden, wenn eine Tumorresektion technisch möglich ist. Als onkologischer Sicherheitsabstand für die Nierentumorresektion konnte gezeigt werden, dass wenige Millimeter ausreichend sind. Präoperativ können verschiedene Klassifikationssysteme herangezogen werden, um das intraoperative Komplikationsrisiko abzuschätzen. Die Nierenteilresektion kann mit oder ohne Ischämie erfolgen. Durch verschiedene Ischämietechniken ist eine suffiziente Nephroprotektion und die nierenerhaltende Resektion komplexer Tumoren möglich. Die Resektionstechnik beinhaltet die Enukleation, Keilresektion und Heminephrektomie bzw. Polresektion sowie bei komplexen Tumoren die extrakorporale Workbench mit renaler Autotransplantation.

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Authors and Affiliations

  1. Urologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    Jan Radtke & Gencay Hatiboglu

  2. Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Dogu Teber

Authors
  1. Jan Radtke
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  2. Gencay Hatiboglu
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  3. Dogu Teber
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Correspondence to Jan Radtke .

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Editors and Affiliations

  1. Universitätsklinikum Mannheim, Klinik für Urologie, Mannheim, Baden-Württemberg, Germany

    Maurice Stephan Michel

  2. Klinik für Urologie, Universitätsklinik Mannheim, Mainz, Germany

    Joachim W. Thüroff

  3. Abt. für Urologie, Universitätsklinikum Salzburg, Salzburg, Austria

    Günther Janetschek

  4. Klinik und Poliklinik für Urologie, Univer Tech Univ Dresden, Dresden, Germany

    Manfred Wirth

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Radtke, J., Hatiboglu, G., Teber, D. (2016). Offene chirurgische Therapie von Nierenparenchymtumoren. In: Michel, M., Thüroff, J., Janetschek, G., Wirth, M. (eds) Die Urologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39940-4_64

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  • DOI: https://doi.org/10.1007/978-3-642-39940-4_64

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