肾癌伴膈下型癌栓的手术治疗  

Surgical treatment of nephrectomy and inferior vena cava thrombectomy in renal cell carcinoma withsubdiaphragmatic thrombus

作　　者：张建平[1] 朱煜[1] 林宗明[1] 张立[1] 孙立安[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

出　　处：《中华泌尿外科杂志》2013年第5期329-332,共4页Chinese Journal of Urology

摘　　要：目的探讨根治性肾切除术加下腔静脉切开取栓术的安全性及有效性，评价术前放置下腔静脉临时滤网及术中充分游离肝脏显露下腔静脉，以避免癌栓脱落栓塞的有效性。方法回顾性分析2004年1月至2010年12月42例肾癌伴膈下型癌栓患者施行根治性肾切除术加下腔静脉切开取癌栓术的临床资料。患者术前均常规置人腔静脉临时滤网，术中12例癌栓位于肝后的患者均采用充分游离肝脏的手法，游离并向左翻开肝脏，显露下腔静脉，依次阻断血流，完成下腔静脉切开取栓。术后当天取出滤网。常规随访。结果42例均完成手术。手术时间130～320min，平均220min；出血量200～2500ml，平均750ml；12例输血，输血量400～2000ml，平均800ml。围手术期未发生有症状的癌栓脱落栓塞。1例术后因严重肺部感染死亡。41例获随访，随访时间6～60个月，平均36个月。37例术前未出现转移的患者中，15例出现转移，22例无瘤生存。结论根治性肾切除术加下腔静脉切开取癌栓术治疗肾癌伴有膈下型下腔静脉癌栓患者较为安全、有效。术前放置下腔静脉临时滤网及术中充分游离肝脏显露下腔静脉，能较有效地避免癌栓脱落，提高手术安全性。Objective To investigate the safety and efficacy of radical nephrectomy plus inferior ve- na cava thrombectomy, and to evaluate the efficacy of preoperative temporary inferior vena cava filter place- ment and intraoperative application of liver transplantation techniques to reveal the inferior vena cava in order to avoid tumor thrombosis shedding and embolism. Methods The data of 42 cases （January 2004 to De- cember 2010） of renal cell carcinoma with subdiaphragmatic thrombus were analyzed retrospectively. All these patients underwent radical nephrectomy plus inferior vena cava thrombectomy. Patients were implanted temporary inferior vena cava filter as preoperative routine. Patients with the tumor thrombi behind the liver were applied liver transplant techniques to free and turn liver to the left in order to reveal inferior vena cava, block blood flow according to priority and then finish the inferior vena cava thrombectomy. The filter was re- moved postoperatively on the same day, and the patients were followed up as routine. Results The opera- tion of the 42 cases was successful without symptomatic tumor thrombus embolism perioperatively, while 1 case died of severe postoperative lung infection. The average operation time was 220 rain （ 130 - 320 rain） , blood loss was 750 ml （200 - 2500 ml） , and 12 cases had blood transfusion with an average of 800 ml （400 -2000 ml）. Forty-one cases were followed up with an average period of 36 months （6 -60 months）. Among the 37 cases without preoperative tumor metastasis, 15 cases had metastases and 22 cases had dis- ease-free survival. Conclusions Nephrectomy and inferior vena cava thrombectomy could be safe and ef- fective for renal cell carcinoma with subdiaphragmatic thrombosis. Preoperative temporary inferior vena cava filter placement and intraoperative application of liver transplantation techniques to reveal the inferior vena cava can be effective to prevent tumor thrombosis shedding and embolism and improve surgical safety.

关 键 词：癌 肾细胞 肿瘤循环细胞 肾切除术 栓子清除术 腔静脉 下 

分 类 号：R737.11[医药卫生—肿瘤]