腔静脉滤器在恶性肾肿瘤合并瘤栓患者治疗中的作用  

Application of inferior vena cava filter in patients with tumor thrombus secondary to malignant renal tumor

作　　者：刘宇军[1] 瞿旭东[2] 许明[1] 张立[1] 林宗明[1] 孙立安[1] 朱同玉[1] 郭剑明[1] 

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032 [2]复旦大学附属中山医院介入科,上海200032

出　　处：《中华泌尿外科杂志》2013年第3期174-178,共5页Chinese Journal of Urology

摘　　要：目的总结放置腔静脉滤器预防根治性肾切除和下腔静脉（IVC）瘤栓取出术中肺栓塞的经验。方法回顾性分析2008年1月至2011年4月20例恶性肾肿瘤合并IVC瘤栓的患者资料。患者术前均放置腔静脉滤器，其中经颈内静脉或股静脉途径放置Tempofiher滤器8例，CookTulip滤器7例，国产Aegisy可回收滤器5例，滤器放置当日或1～11d后手术。行单纯根治性肾切除4例，其中T4N2M0期（瘤栓Ⅲ级）1例，T3bN2M0（瘤栓Ⅱ级）1例，T3cN0M0期（瘤栓Ⅳ级）2例；2例T4N2M0期肿瘤（瘤栓Ⅱ级）行剖腹探查＋活检术；根治性肾切除＋IVC切开取栓术14例。18例术后1～14d拔除滤器。对滤器放置方法、取栓技术和相关并发症进行讨论。结果20例患者均未发生肺栓塞或与放置滤器有关的并发症。术中输血10例，输血量500～5000ml[（1930±1405）ml]。IVC阻断不完全、腰静脉等侧支静脉开放是术中失血的重要原因。术后并发急性肾衰竭1例，下肢深静脉血栓1例，拔除滤器当天发生肺栓塞1例，3例均与软血栓栓塞有关，经抗凝等保守治疗治愈。结论放置腔静脉滤器可以有效防止根治性肾切除和IVC取栓术中肺栓塞并发症的发生。该法安全易行、移除方便，对于0级以上、合并软血栓和侧支循环开放的高危患者，可作为常规预防措施。出血是取栓术最常见的并发症，充分游离并阻断瘤栓上、下方IVC、避免侧支静脉损伤是减少输血量的关键。Objective To summarize the experience of implantation of inferior vena cava （IVC） filter for pulmonary embolism prevention during radical nephrectomy and IVC thrombus resection for malignant renal tumor. Methods Total 20 patients with malignant renal tumor and IVC tumor thrombus were per- formed IVC filter implantation via superior vena caval approach （ right internal jugular vein） or right femoral vein approach from January 2008 to April 2011, including Tempofilter （ B. Braun Medical Inc, USA） in 8 cases, Cook Tulip （ Cook company, USA） in 7 cases and Aegisy temporary IVC filter （ Shenzhen, China） in 5 cases. The filter was inserted at the morning of surgery or 1 - 11 days prior to nephrectomy under local anesthesia. Radical nephrectomy was performed in 4 cases, including 1 T4N0M0 （ tumor thrombus level grade m）, 1 T3hN2Mo（grade ll）, and 2 T3cNoM0（grade IV）. Laparotomy and biopsy were done in 2 cases whose tumors were T4N2M0（ grade Ⅱ） , and radical nephrectomy plus IVC thrombus resection were done in the other 14 cases. IVC filters were removed 1 - 14 days after operation in 18 cases or remain indwelling in 2 cases. The methods of filter implantation, technique of nephrectomy and IVC thrombus resection and complications were discussed. Results There were no complications related to the filter implantation or intraoperative pulmonary embolism occurred. The intraoperation blood transfusion were required in 10 patients （50%） , and amount ranged from 500 -5000 ml, with mean （1930 -＋ 1405） ml. Incompletely IVC control and unrecongnized venous branches such as lumbar veins were the important risk factor of blood loss. Postop- erative acute renal failure and deep femoral vein thrombosis occurred in 1 patient. Pulmonary embolism oc- curred in 1 case in the day of IVC filter removed. All these postoperative complications were relative with bland thrombus and cured by conservative methods such as auticoagulation. Conclusions The IVC filter is effective in preventing pulmonar

关 键 词：肾肿瘤 恶性 瘤栓 腔静脉滤器 

分 类 号：R737.11[医药卫生—肿瘤]