后腹腔镜联合开放治疗肾癌Ⅳ级下腔静脉瘤栓  

Retroperitoneal laparoscopy combined with open surgery for renal cell carcinoma with level Ⅳ vena cava thrombus

作　　者：纪长威[1] 张古田[1] 王强[2] 赵晓智[1] 连惠波[1] 张士伟[1] 郭宏骞[1] 

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,江苏南京210008 [2]南京大学医学院附属鼓楼医院心胸外科,江苏南京210008

出　　处：《现代泌尿外科杂志》2015年第5期306-309,共4页Journal of Modern Urology

基　　金：2013年度南京市医学科技发展项目一般性课题(YKK13055)

摘　　要：目的：探讨后腹腔镜联合开放手术治疗肾癌合并Ⅳ级下腔静脉瘤栓的安全性及临床效果。方法2004年2月至2014年8月我院肾癌合并Ⅳ级下腔静脉瘤栓患者7例，采用肾癌根治性切除加深低温停循环下腔静脉瘤栓取出术。4例为开放手术，3例为后腹腔镜联合开放手术。结果7例患者手术均成功完成。与开放手术组相比，后腹腔镜组的出血量和切口长度明显减少（P＜0．05）。两组间的平均手术时间、深低温停循环时间、术后住院时间无明显统计学差异（P＞0．05）。1例患者因术后出血死亡，余6例围手术期无重大并发症发生。随访4～108个月，2例因肺转移于术后2年内死亡，4例患者存活。结论后腹腔镜联合开放手术可以缩短切口长度、减少出血量、降低手术创伤。ABSTRACT：Objective To explore the efficacy and safety of retroperitoneal laparoscopy combined with open surgery for renal cell carcinoma with level IV vena cava thrombus .Methods Clinical data of 7 cases of renal cell carcinoma and level IV inferior vena cava thrombus treated during Feb .2004 to Aug .2014 were retrospectively analyzed .Cardiopulmonary bypass （CPB） with deep hypothermic circulatory arrest （DHCA） was applied for thrombectomy in all patients .Four patients under‐went simple open surgery ,and 3 patients underwent retroperitoneal laparoscopy combined with open surgery .Results All operations were technically successful .The tumor and vena cava thrombus were completely resected and no invasion of the ca‐val wall was observed .One patient died of postoperative bleeding .Compared with the retroperitoneal laparoscopic group ,the open surgery group had more blood loss and longer incision length （2737 .5 vs .850 mL ,60 .5 vs .47.7 cm ,both P0 .05） .During the follow‐up of 4 to 108 months （mean 46 .3 months） ,2 patients died due to lung metastasis in month 22 and 24 respectively ,and 4 patients were alive .Conclusions Retroperitoneal laparoscopy combined with open sur‐gery could significantly reduce blood loss and incision length .

关 键 词：肾细胞癌 下腔静脉瘤栓 深低温停循环 后腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]