腔静脉节段切除术在处理侵犯腔静脉的肾肿瘤瘤栓中的应用  

Segmental vena cava resection for the treatment of renal tumor with invading tumor thrombus

作　　者：叶剑飞[1] 马潞林[1] 赵磊[1] 王国良[1] YE Jian-fei;MA Lu-linA;ZHAO Lei;WANG Guo-liang(Department of Urology, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191

出　　处：《北京大学学报（医学版）》2018年第1期183-187,共5页Journal of Peking University:Health Sciences

摘　　要：目的:探讨腔静脉节段切除术治疗侵犯腔静脉的肾肿瘤瘤栓的可行性、安全性和手术经验。方法:2015年5月至2017年7月,北京大学第三医院共收治92例肾肿瘤伴静脉瘤栓的患者,其中17例患者因瘤栓侵犯腔静脉壁需行腔静脉节段切除术。本组病例的特点为:男性15例、女性2例,平均年龄为(59.2±12.9)岁(31~84岁);左侧6例,右侧11例;Mayo静脉瘤栓分级Ⅱ级10例、Ⅲ级3例、Ⅳ级4例;肾肿瘤最大径平均为(9.1±3.7)cm(3.0~14.5 cm)。结果:所有患者均成功完成手术,5例腹腔镜下完成(中转开放2例),12例开放手术完成(伴体外循环2例),平均手术时间为(430.4±120.7)min(284~694 min),术中平均失血量为(2 918.8±2 608.2)m L(300~10 000 m L)。腔静脉内瘤栓中位长度为10 cm(3~21 cm),手术切除范围是从瘤栓顶端水平到瘤栓底部水平。发生术后并发症患者11例,分别为Clavien分级Ⅰ级1例、Ⅱ级7例、Ⅳ级2例和Ⅴ级1例(术后第2天因大出血死亡)。术后肌酐中位数为116μmol/L(79~645μmol/L),其中2例需术后床旁血液滤过或透析。术后病理为肾透明细胞癌10例、乳头状细胞癌2型5例、尿路上皮癌1例、梭形细胞肉瘤1例。中位随访时间为8个月(1~28个月),1例围术期死亡,1例术后9个月因多发转移死亡,3例患者发现远处转移,2例术后随访3~6个月仍有双下肢水肿,其余患者恢复情况和治疗效果良好。结论:对于某些侵犯腔静脉的肾肿瘤瘤栓的患者,可行腔静脉节段切除完成手术,短期随访手术效果良好。Objective： To investigate the safety and perioperative experience o f the segmental resection of the vena cava. Methods ： From May 2015 to July 2017, 92 renal tumor patients w ith venous tumor thrombus were treated in Peking University T h ird Ho s p ita l, o f whom 17 underwent nephrectomy w i th re-section of the invaded vena cava for renal tumor w i th tumor thrombus invad ing vena cava. The preopera-tive features included that 15 patients were male and 2 fem a le, the mean age was （59. 2 ± 12. 9） years （31 -84 years） , 6 cases were lef t sided and 11 r ig h t s id e d, and the mean diameter o f the renal tumor was （9. 1 ± 3.7） cm （3 - 14. 5 cm ） ？ Results： In this group o f 17 cases, 5 patients underwent resection of the vena cava via laparoscopy （ including 2 open conversions） , and 12 via open procedures （ in c lu d in g 2 cardiopulmonary bypasses） . The mean operation time was （430.4 ±120.7） min （284 -694 m in ） and the mean intraoperative blood loss was （2 918. 8 ± 2 608. 2） mL （300 - 10 000 m L ） . The vena cava from the bottom to the top was transected. The median length o f the tumor thrombus in the vena cava was 10 cm （3 - 21 cm ） . Postoperative complications were found in 11 p a t ie n ts, in c lu d in g grade I in 1 case, grade II in 7 cases, grade IV in 2 cases and grade V in 1 case according to the Clavien system.The median postoperative creatinine was 116 （ xmol /L （79 -645 （ xmol/L ） w i th 2 patients needing d ia ly-sis. The postoperative pathology revealed that renal clear c e l l carcinoma in 10 cases, p a p i l la ry carcinoma in 5 cases, urothelial carcinoma in 1 case and fusiform c e l l sarcoma in 1 case. Du r ing the median fo l low -up of 8 （1 - 28 ） months, 1 patient died d u r in g perioperative p e r io d , 1 pat ient died from m u l t ip le metas-tasis in 9 months postoperat ively, 3 patients found distant metastasis and 2

关 键 词：肾肿瘤 腔静脉 血管肿瘤 瘤栓 血管外科手术 

分 类 号：R737.11[医药卫生—肿瘤]