肾癌伴下腔静脉癌栓的诊断与治疗  

Diagnosis and treatment of renal cell carcinoma involving inferior vena cava

作　　者：蔡松良[1] 罗金旦[1] 万群[1] 张志根[1] 金百冶[1] 陈戈明[1] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003

出　　处：《中华泌尿外科杂志》2005年第8期516-519,共4页Chinese Journal of Urology

摘　　要：目的探讨肾癌伴下腔静脉癌栓的诊断及治疗.方法回顾性分析1997年1月至2003年11月21例肾癌伴下腔静脉癌栓患者资料,男13例,女8例,平均年龄50岁.右侧13例,左侧8例.临床表现主要为腰痛和(或)血尿.经彩色多普勒超声、CT和MRI确诊.I型癌栓3例,Ⅱ型10例,Ⅲ型6例,Ⅳ型2例.其中行肾癌根治术加下腔静脉癌栓取出术15例,肾癌根治术加下腔静脉节段切除术4例.结果19例手术者中,8例术后仅存活3～13个月,11例随访4～57个月至今,无瘤生存8例,带瘤生存3例.2例未行手术者分别于3、5个月后死亡.结论彩色多普勒超声、CT和MRI对肾癌伴下腔静脉癌栓诊断率较高,可准确判断癌栓位置.对无淋巴结和远处转移者,积极行肾癌根治术加下腔静脉癌栓取出术或下腔静脉节段切除术治疗效果满意.Objective To evaluate the diagnosis, treatment and prognosis of renal cell carcinoma （RCC） with tumor thrombus in the inferior vena cava. Methods The data of 21 cases （ 13 males and 8 females with a mean age of 50 years） of RCC involving the inferior vena cava were analyzed retrospectively. Of the 21 cases, 13 had the tumor on the right side and 8 ,on the left. The main complaints consisted of low back pain and hematuria. The diagnoses were confirmed by Doppler uhrasonography, CT and MRI. The tumor thrombus was in level Ⅰ in 3 cases,level Ⅱ in 10,level Ⅲ in 6 and level Ⅳ in 2. Radical nephrectomy with extraction of the thrombus was carried out on 15 patients, and radical nephrectomy and sectional venacavorectomy, on 4 patients. Results Of the 19 patients undergoing operation, 8 died 3 - 13 months postoperatively; 11 survived for 4 - 57 months,among whom 8 survived without tumor. The 2 patients who refused operation died 3 and 5 months later,respectively. Conclusions Doppler uhrasonography, CT and MRI have a high accuracy in the diagnosis of RCC with tumor thrombus in the inferior vena cava. The extent of the thrombus can be visualized on them. Aggressive surgical strategy is recommended for the patient without lymph node involvement and distant metastases.

关 键 词：肾癌 下腔静脉癌栓 诊断 治疗 肿瘤细胞 

分 类 号：R737.11[医药卫生—肿瘤]