肾癌合并静脉癌栓诊疗方式的探讨及疗效观察  

Diagnosis,treatment and prognosis of renal carcinoma combined with venous tumor thrombus

作　　者：王劲夫[1] 王建业[1] 万奔[1] 魏东[1] 张力青[1] 邓京平[1] 邓庶民[1] 朱生才[1] 苏鸿学[1] 张耀光[1] 刘明[1] 金滨[1] 张亚群[1] 王建龙[1] 王鑫[1] 陈鑫[1] 马宏[1] 吴鹏杰[1] 

机构地区：[1]北京医院泌尿外科,北京100730

出　　处：《临床泌尿外科杂志》2015年第7期597-600,共4页Journal of Clinical Urology

摘　　要：目的：探讨肾癌合并静脉癌栓的诊疗方式,观察整体生存状况及静脉癌栓级别对预后的影响。方法：回顾性分析我院2005年6月~2013年4月收治的21例肾癌合并静脉癌栓患者临床资料：男16例,女5例,平均年龄（58.9±14.9）岁。癌栓级别1级（癌栓位于肾静脉内）9例,2级（癌栓位于肾静脉以上膈肌以下）10例,3级（癌栓位于膈肌以上）2例。18例行手术治疗。采用Kaplan-Meier法进行生存分析,采用Log-rank检验分析癌栓级别对预后的影响。结果：B超、增强CT和MRI对静脉癌栓的检出率分别为52.4%、100%和92.9%;18例行手术治疗的患者平均手术时间（247.2±86.6）min,平均术中出血量（2 233.3±2 848.2）ml,平均术后放置引流管时间（6.9±6.4）d,平均住院时间（28.4±18.8）d。中位随访时间65个月,中位生存时间54个月,5年总生存率为36.8%。Log-rank检验分析显示静脉癌栓级别是影响预后的危险因素（P〈0.05）。结论：增强CT或MRI评估癌栓准确率高;肾癌合并静脉癌栓的治疗方式仍以手术为主,但风险高,围术期并发症发生率高;癌栓级别与预后相关。Objective：To investigate the diagnosis, treatment and prognosis of renal carcinoma combined with venous tumor tbrombus （VTT） and to evaluate the prognosis of patients with different level of VTT. Method： From June 2005 to April 2013, 21 patients were diagnosed as renal carcinoma combined with VTT including 16 males and 5 females. The mean age was （58. 9 ± 14. 9） years old. Nine patients were level 1 VTT （tumor thrombus in renal vein）, and 10 patients were level 2 VTT （tumor thrombus above the renal vein and below the diaphragm）. The rest two patients were level 3 VTT （tumor thrombus above diaphragm）. Eighteen patients were treated with surgery. Survival analysis was estimated by Kaplan-Meier method. The influence of different level of VTT on prognosis was tested using log-rank test analysis. Result：The detection rate for VTT of ultrasonography, enhanced CT scan and MRI was 52.4%, 100% and 92.9% respectively. Patients＇ clinical data were as follows： mean operative time was （247.2±86.6） minutes; mean intraoperative blood loss was （2 233.3±2 848.2） ml; mean urethral catheter indwelling time was （6.9± 6.4） days; mean hospitalization time was （28.4± 18.8） days. The median follow-up period was 65 months. The median survival time was 54 months and the five-year survival was 36.8%. Log-rank test analysis showed that level of VTT was a risk factor affecting the prognosis （P〈 0.05）. Conclusion：Enhanced CT scan and MRI have high accuracy to identify VTT. The preferred treatment for renal carcinoma combined with VTT is surgery. But surgery is accompanied with high risks and high incidence of perioperative complications. Level of VTT is related to prognosis.

关 键 词：肾癌 静脉癌栓 手术 生存分析 

分 类 号：R737.11[医药卫生—肿瘤]