肾癌腔静脉癌栓的诊断与治疗  

Diagnosis and Treatment of Renal Cell Carcinoma with Vena Cava Tumor Thrombi

作　　者：李晓飞[1] 周芳坚[2] 丘少鹏[1] 刘卓炜[2] 吴荣佩[1] 黄凯[1] 梅骅[1] 

机构地区：[1]中山大学附属第一医院泌尿外科,广东广州510080 [2]中山大学肿瘤防治中心泌尿外科,广东广州510060

出　　处：《癌症》2004年第9期1074-1076,共3页Chinese Journal of Cancer

摘　　要：背景与目的:肾癌可侵犯肾静脉,形成癌栓延伸至腔静脉,甚至右心房。肾癌腔静脉癌栓临床处理困难,但是在根治性肾切除时取尽癌栓,患者可获得长期生存。本文报告我们处理肾癌腔静脉癌栓的体会。方法:回顾性分析1995年5月～2003年10月经手术治疗的14例肾癌腔静脉癌栓患者的临床资料,包括术前诊断、手术方法和患者的预后。结果:B超发现腔静脉癌栓9例,漏诊5例;CT诊断癌栓12例,漏诊2例;8例MRI检查均发现腔静脉癌栓并对癌栓范围显示清楚。14例中肝下腔静脉癌栓12例、肝内膈下和膈上腔静脉癌栓各1例,术后随访时间6～37个月,13例无瘤生存,1例(ⅢC患者)于术后23个月因癌死亡。结论:B超和CT是诊断肾癌腔静脉癌栓常用方法,MRI判断癌栓范围较B超和CT准确。对没有淋巴和远处转移的肾癌腔静脉癌栓患者外科治疗能获良好的远期效果。BACKGROUND &OBJECTIVE: Renal cell carcinoma (RCC) might involve th e renal vein, and form tumor thrombus extending into the vena cava or the right atrium. Treating RCC with vena cava involvement is difficult in clinical practic e. Radical nephrectomy with complete tumor thrombus removal could result in good outcomes for RCC patients with vena cava thrombi. This paper was to report our experiences on treating RCC with vena cava thrombi. METHODS: From May 1995 to Oc t. 2003, radical nephrectomy plus vena cava thrombus removal was performed in 14 RCC patients. Clinical records, including preoperative diagnosis, operation pat tern, and prognosis, of these 14 patients were analyzed retrospectively. RESULTS : Vena cava thrombi were detected in 9 patients, and missed in 5 patients by ult rasonography. CT scan revealed vena cava thrombi in 12 of 14 patients. MRI has b een performed in 8 patients, and clearly demonstrated extent of the thrombus. Tw elve cases of tumor thrombi within infrahepatic vena cava, 1 within intrahepatic subphrenic vena cava, and 1 within supraphrenic vena cava. The patients have be en followed up for 6-70 months after surgery. Thirteen patients survived with d isease-free, and 1 patient (stage IIIc) died of cancer 23 months after surgery. CONCLUSION: Vena cava thrombi in patients with RCC could be detected on CT scan and ultrasonography. MRI is more accurate than CT,and ultrasonography in deline ating extent of the thrombus. Radical nephrectomy plus vena cava thrombus remova l could achieve long-term survival for patients with localized RCC and vena cav a thrombi.

关 键 词：肾肿瘤 腔静脉 癌栓 外科手术 

分 类 号：R737.11[医药卫生—肿瘤]