肾癌下腔静脉癌栓的诊断和手术方法的探讨——附6例临床分析并文献复习  

Diagnosis and Surgical Management of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus -- a Report of 6 Cases with Literature Review

作　　者：李新德[1] 成晟[1] 芮雪芳[1] 李恭会[1] 陈岳兵[1] 余大敏[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院泌尿外科,浙江杭州310016

出　　处：《癌症》2005年第11期1394-1397,共4页Chinese Journal of Cancer

摘　　要：背景与目的:肾癌下腔静脉癌栓临床处理困难,肾癌根治性切除的同时再切除肾静脉癌栓和取出下腔静脉癌栓,预后仍然良好。术前明确诊断,特别是对癌栓延伸范围的判断,对手术方式的选择十分重要。本研究结合我们的经验,进一步探讨肾癌下腔静脉癌栓的诊断和手术治疗。方法:回顾性分析我院2000～2004年收治的6例肾癌并发下腔静脉癌栓患者的临床资料,包括诊断方法、手术治疗和预后。结果:6例患者术前均经B超、CT和MRI明确诊断,肾静脉型1例,肝下型3例,肝内型2例;1例肝内型患者术中死亡,余5例均手术成功。术后随访3～30个月,1例肝下型和1例肝内型患者分别于术后9个月、3个月死于远处转移,其余3例仍存活。结论:CT、MRI是目前无创诊断肾癌伴下腔静脉癌栓的最佳方法;对无淋巴结和远处转移的患者,应积极手术治疗;手术方式的选择取决于癌栓的延伸范围以及是否侵犯下腔静脉壁。BACKGROUND ＆ OBJECTIVE. The management of renal cell carcinoma （RCC） with inferior vena cava （IVC） tumor thrombus is difficult in clinical practice. Complete surgical removal of the primary tumor with its extension along the IVC is the only hope for a potential cure. The diagnosis of vena caval invasion, especially the determination of tumor thrombus extension, is important for surgical approach planning. This report was to summarize our experiences on treating RCC with IVC tumor thrombus, and explore the diagnosis and surgical management. METHODS： Clinical data, including preoperative diagnosis, operation pattern, and prognosis, of 6 RCC patients with IVC tumor thrombus, treated from 2000 to 2004 in our hospital, were reviewed retrospectively. RESULTS： Diagnoses of the 6 cases of RCC with IVC tumor thrombus were made by ultrasonography, computed tomography （CT）, or magnetic resonance imaging （MRI） preoperatively. Of the 6 cases, 1 was renal vein thrombus, 3 were infrahepatic thrombus, 2 were hepatic thrombus. Operations were performed for all 6 patients with 5 successes except 1 death during the operation. The patients were followed-up for 3-30 months after operation; 2 died of distant metastases 3 and 9 months after operation, and the other 3 survived disease-freely. CONCLUSIONS： CT and MRI are the best ways to diagnose RCC with IVC tumor thrombus. Surgical treatment is the preferred approach for the patients without distant metastases and lymph node involvement. Surgical strategy depends on the tumor thrombus extension and the vena wall involvement status.

关 键 词：肾肿瘤/外科手术 下腔静脉 癌栓 诊断 

分 类 号：R737.11[医药卫生—肿瘤]