TempofilterⅡ滤器在肾癌伴静脉癌栓手术治疗中的应用(附18例报告)  

The application of Tempofilter Ⅱ in radical nephrectomy and tumor thrombus resection for renal cell carcinoma

作　　者：于宏志[1] 房杰[1] 高翔[1] 张喆[1] 刘彬[1] 李晨宇[1] 陈学明[1] 

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050

出　　处：《中国血管外科杂志（电子版）》2016年第4期286-290,共5页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的总结肾癌合并静脉癌栓行根治手术前,预先植入TempofilterⅡ临时滤器预防肺栓塞的效果。方法回顾性分析2013年1月至2016年5月18例确诊为肾癌合并静脉癌栓的患者资料,预先植入TempofilterⅡ临时滤器,后行肾癌切除和静脉癌栓取栓术,并于术中或术后取出滤器。肾静脉及下腔静脉癌栓分级：0级4例,Ⅰ级2例,Ⅱ级10例,Ⅲ级2例。结果全部患者先行植入下腔静脉TempofilterⅡ临时滤器,技术成功率100%,无相关围术期并发症发生。术后取出临时滤器时间间隔为0~9天[平均为（4.1±2.5）天]。取出的滤器均形态完整,无滤丝折断、滤器移位发生。1例患者于滤器取出术后3个月发现颈部皮肤转移癌。结论对于肾癌合并静脉癌栓患者,预先植入TempofilterⅡ临时滤器预防肺栓塞是安全、可行的。滤器取出过程需要加以改进,以减少医源性肿瘤脱落种植风险。Objective To evaluate the efficacy of pulmonary embolism（PE） prevention of preoperative temporary inferior vena cava filter （IYCF） placement in patients with renal cell carcinoma （RCC） and tumor thrombus extending into the renal vein or inferior vena cava（IVC）. Methods The clinical data of 18 patients with RCC and tumor thrombus extending into the renal vein or IVC, treated with implantation of a temporary suprarenal IVCF, and subsequent radical nephrectomy and tumor thrombus resection from January 2013 to May 2016, were retrospectively reviewed. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the 0 to IE classification, and 4 patients were classified as level 0, 2 as level I , 10 as level II , and 2 as level Et. Results All filters were properly deployed in the suprarenal tract of the IYC. There was no evidence of peri procedural complications. All temporary IVCFs were successfully removed in the period from 0 to 9th day after surgery, with filters intact without fracture or migration. Metastatic carcinoma of the neck skin was found in one patient 3 months after operation. Conclusion Implantation of a temporary IVC filter is a safe and feasible procedure that can prevent immediate and perioperative PE. The process of filter retrieval should be improved in order to reduce the risk of iatrogenic tumor implantation.

关 键 词：下腔静脉 肾癌 癌栓 静脉滤器 医源性肿瘤种植 

分 类 号：R737.11[医药卫生—肿瘤]