肾肿瘤合并下腔静脉瘤栓的外科处理——115例回顾性分析  

Surgical management of renal neoplasm extending into the inferior veno cava

作　　者：肖序仁[1] 陈湘龙[1] 朱宏建[1] 贾永中 吴学杰[1] 庞栋[1] 张庆江[1] 王华[1] 王立新[2] 王奇[2] 张磊[3] 叶林阳[3] 洪宝发[3] 蔡伟[3] 高江平[3] 杨勇[3] 王茂强[4] 高长青[5] 崔亮[6] Xiao Xuren Chen Xianglong Zhu Hongjiang Jia Yongzhong Wu Xuejie Pang Dong Zhang Qingjiang Wang Hua Wang Lixing Wang Qi Zhang Lei Ye Linyang Hong Baofa Cai Wei Cao Jiangping Yang Yong Wang Maoqiang Gao Changqing Cui Liang(Departments of Urology, The General Hospital of Chinese People Armed Police Forces, Beijing 100039, China)

机构地区：[1]中国武警总医院泌尿外科,北京100039 [2]中国武警总医院心外科,北京100039 [3]解放军总医院泌尿外科 [4]解放军总医院介入放射科 [5]解放军总医院心外科 [6]中国民航总医院泌尿外科

出　　处：《中华泌尿外科杂志》2017年第1期9-14,共6页Chinese Journal of Urology

摘　　要：目的总结115例肾肿瘤合并下腔静脉瘤栓的外科处理方法和疗效。方法回顾性分析1993年3月至2015年12月收治的115例肾肿瘤合并下腔静脉瘤栓患者的临床资料，男74例，女41例。年龄22～77岁，平均52岁。肾肿瘤位于右侧77例，左侧38例。瘤栓分型：肾静脉型15例（13.0%），肝下型38例（33.1%），低位肝后型29例（25.2%），高位肝后型20例（17.4%），膈上/心房型13例（11.3%）。115例均接受了根治性外科手术。主要观察结果为肿瘤与瘤栓的完全切除率以及肾细胞癌（renal cell carcinoma，RCC）患者的总生存率（overall surviva，OS）和肿瘤特异性生存率（cancer specific survival，CSS），均采用Kaplan－Meier法计算。次要观察结果包括手术与肿瘤学特征、术后并发症发生率及住院病死率。对可能影响RCC患者生存的因素采用Cox风险比例模型进行单因素和多因素分析。结果本组115例手术，除2例术中因瘤栓脱落死亡外，余113例（98.3%）的肿瘤和瘤栓均完全切除。术后并发症发生率为16.8%（19/115），其中1例死亡，总住院病死率为2.6%（3/115）。术后平均随访48个月，RCC患者术后5、10年的OS分别为66.5%和61.8%。肿瘤转移（P＝0.000）是影响RCC患者生存的独立危险因素，而瘤栓级别（P＝0.357）不是影响患者预后的因素。结论外科手术是RCC合并下腔静脉瘤栓患者的有效治疗方法，可延长患者的存活时间。低于或高于肝静脉的肝后型下腔静脉瘤栓是两种不同的类型，需要采用不同手术方法切除。影响RCC患者术后生存的独立危险因素是肿瘤转移，而非瘤栓级别。Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava. Methods We review the data of 115 patients,including 74 male patients and 41 female patients, with renal neoplasm involving venous system between March 1993 and December 2015. The mean age was 52 years old, ranging 22 to 77 years old. The tumor was found in right side in 77 cases and left side in 38 cases. There were 15 patients （ 13.0% ） with renal vein thrombus, 38 （33.1%） with infrahepatic thrombus, 29 （ 25.2% ） with low retrohepatic thrombus, 20 （ 17.4% ） with high retrohepatic thrombus, and 13 （ 11.3% ） with supradiaphragmatic thrombus. The mean age was 52 years old, ranging 22 to 77 years old. The tumor was found in right side in 77 cases and left side in 38 cases. All patients accepted the radical nephrectomy. Primary outcomes were overall survival （OS）, and cancer special survival （CSS） in patients with renal cell carcinoma （RCC） estimated by Kaplan-Meier method. Secondary outcome included operative and oncological features, past-operative complications and hospital mortality. Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients. Results Complete reseetions of renal neoplasm with tumor thrombus were achieved in 113 patients （98.3%）, 2 patients died intraoperatively due to the dropping of thrombus. Postoperative complication rate was 16. 8%. Hospital mortality was 2.6%. Mean follow-up interval was 48 months. OS rates at 5-, and 10-year in RCC patients were 66. 5%, and 61.8%, respectively. Metastasis was an independent risk factor affecting on OS （ P = 0. 000）. However, the level of thrombus was not an risk factor affecting the prognosis. Conclusions Radical resection of renal tumor and caval thrombus is an effeetive treatment for prolonging survival in patients with RCC extending into venous system. Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichot

关 键 词：肾肿瘤 肾细胞癌 下腔静脉瘤栓 下腔静脉瘤栓切除术 

分 类 号：R737.11[医药卫生—肿瘤]