体外循环下腹腔镜、胸腔镜联合小切口治疗肾癌合并Ⅳ级癌栓的安全性和疗效分析  

Combination of thoracoscopy and laparoscopy for the small incision surgical management of renal cell carcinoma and level Ⅳ tumor thrombus in inferior vena cava by extracorporeal circulation

作　　者：秦超[1] 邵鹏飞[1] 李普[1] 李杰[1] 居小兵[1] 朱锦富[2] 吴延虎[2] 邵永丰[2] 陈宇[3] 孟小鑫[1] 吕强[1] 宋宁宏[1] 殷长军[1] 

机构地区：[1] 南京医科大学第一附属医院泌尿外科,210029 [2] 南京医科大学第一附属医院胸心外科,210029 [3] 南京医科大学第一附属医院麻醉科,210029

出　　处：《中华泌尿外科杂志》2014年第6期414-417,共4页Chinese Journal of Urology

摘　　要：目的 探讨体外循环下运用腹腔镜、胸腔镜联合小切口治疗肾癌合并Ⅳ级癌栓的可行性及安全性. 方法 回顾性分析2011年8月至2013年5月5例肾癌合并Ⅳ级癌栓患者的临床资料.男4例,女1例.年龄46～67岁.均有无痛性肉眼血尿,腰痛3例,发热1例,均无下肢水肿或腹壁静脉曲张等下腔静脉阻塞表现.影像学检查均提示右肾占位,肿瘤直径8～13 cm,平均11 cm,下腔静脉癌栓长度为16～23 cm,平均19 cm.均在体外循环下运用腹腔镜、胸腔镜联合小切口行根治性肾切除和癌栓取出术. 结果 5例手术均成功,未发生癌栓脱落.手术时间330～ 420 min,平均370 min,其中血流阻断时间55～73 min,平均65 min.术后住院7～13d,平均9d.随访6～26个月,平均17个月.1例患者术后6个月死于脑转移,其余4例无复发及转移. 结论 对于无淋巴结和远处转移的肾癌伴Ⅳ级癌栓形成的患者,在体外循环下腹腔镜、胸腔镜联合小切口治疗肾癌合并Ⅳ级癌栓有效且安全.Objective To explore the feasibility and safety of combination of thoracoscopy and laparoscopy for the small incision surgical management of renal cell carcinoma and level Ⅳ tumor thrombus in inferior vena cava （IVC） by extracorporeal circulation.Methods The data,including preoperative diagnosis,operation pattern and prognosis,of 5 cases of renal cell carcinoma involving level Ⅳ tumor thrombus in IVC were analyzed retrospectively form Aug.2011 to May.2013.The 5 patients included 4 men and 1 woman aged from 46 to 67 years.All patients presented painless gross hematuria,3 cases with backache,1 case with fever,no case with lower extremity edema,abdominal wall varicosis or any other clinical manifestations due to obstruction of IVC.All the patients were examined with ultrasonography,computed tomography and magnetic resonance imaging which depicted lesions in the right kidney,tumor thrombus in IVC with a mean length of 19 cm （range 16-23 cm）.All 5 cases were performed with radical resection of renal tumor and removal of tumor thrombus in IVC by combination of thoracoscopy and laparoscopy.Results All 5 cases were successfully performed with radical resection of renal tumor and removal of tumor thrombus in IVC.The shedding of the tumor thrombus did not occur in all cases.The mean operative time was 370 min （range 330-420 min） and the mean blood blocking time was 65 min （range 55-73 min）.The average hospital stay was 9 d （range 7-13 d）.With a mean follow-up of 17 months （6-26 months）,1 patient died of brain metastasis at 6 months postoperatively.No recurrence or metastasis of tumors occurred in other patients.Conclusion For the patients without lymph node involvement and distant metastasis,combination of thoracoscopy and laparoscopy for the small incision surgical management of renal cell carcinoma and level Ⅳ tumor thrombus in IVC by extracorporeal circulation is feasible and safe.

关 键 词：肾肿瘤 癌栓 体外循环 

分 类 号：R737.11[医药卫生—肿瘤]