经腹运用肝脏游离技术治疗肾癌合并肝后下腔静脉瘤栓  

Transabdominal approach and the use of liver transplant techniques for the treatment of retrohepatic cava thrombosis concomitant to renal cell carcinoma

作　　者：江山[1] 梁朝朝[1] 施浩强[1] 张贤生[1] 

机构地区：[1]安徽医科大学第一附属医院泌尿外科,合肥230022

出　　处：《现代泌尿生殖肿瘤杂志》2013年第5期262-265,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的 探讨经腹运用肝脏游离技术治疗肾癌合并肝后下腔静脉瘤栓的安全性和有效性.方法 2002年至2012年我院收治16例肾癌合并肝后下腔静脉瘤栓患者,15例经腹运用肝脏游离技术显露下腔静脉,完整切除瘤栓和根治性肾切除.结果 手术中无一例发生死亡,平均手术时间130～320 min,术中失血约200～1 000 ml,所有瘤栓均被完全切除,术中无栓塞发生.结论 经腹运用肝脏游离技术可以充分显露肝后的下腔静脉,对于肝后下腔静脉瘤栓以及部分膈上下腔静脉瘤栓可以运用肝脏游离技术经腹完全切除,避免经胸手术和心肺分流.Objective To study the feasibility and safety of applying the use of liver transplant techniques for the treatment of retrohepatic cava thrombosis concomitant to renal cell carcinoma. Methods Between 2002 and 2012, 15 patients with renal cell carcinoma and tumor thrombus exten- ding into IVC （retro-hepatic） underwent radical nephrectomy and thrombectomy. All patients under- went piggyback style mobilization of the liver off of the retrohepatic inferior vena cava to allow en- hanced access and vascular control. All cava tumors were resected using an abdominal approach. Results No intraoperative deaths, Mean operative time was 130 to 320 minutes. The estimated blood loss ranged from 200 to 1 000 ml. All had complete tumor resection. No patient developed in- traoperative thromboembolism. Conclusions This surgical approach provides excellent exposure and control of the IVC, patients with retrohepatic or even some suprahepatic inferior vena cava thrombus may be treated without sternotomy or thoracotomy and cardiopulmonary bypass.

关 键 词：肾癌 下腔静脉瘤栓 肝脏游离技术 根治性肾切除 

分 类 号：R737.11[医药卫生—肿瘤]