肾细胞癌伴下腔静脉癌栓术中癌栓脱落的危险因素分析  

Analysis of Risk Factors for Tumor Embolus Detachment in Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

作　　者：赖鹏 林宗明[2] 郭剑明[2] 张立[2] 张建平[2] LAI Peng;LIN Zongming;GUO Jianming(Xiamen Branch Zhongshan Hospital of Fudan University,Xiamen 361000,China)

机构地区：[1]复旦大学附属中山医院厦门医院,福建厦门361000 [2]复旦大学附属中山医院

出　　处：《中外医学研究》2018年第18期14-16,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:在肾细胞癌伴有下腔静脉癌栓患者中,通过术前放置下腔静脉临时滤器的方法,来确定癌栓脱落的危险因素,以期术前评估癌栓脱落的风险。方法:回顾性分析2004年1月-2014年6月笔者所在医院收治的62例肾细胞癌伴有Ⅰ~Ⅲ级下腔静脉癌栓的临床资料,术前明确患者的癌栓水平、癌栓是否与无瘤血栓相混杂、是否存在深静脉血栓、是否有近期肺栓塞史、原发肿瘤的大小,术前均放置下腔静脉临时滤器,行肾根治性切除加下腔静脉切开取癌栓术,术后下腔静脉造影,根据癌栓捕获与否分为癌栓脱落阳性组和阴性组,分析两组间上述影响癌栓脱落的因素。结果:62例患者中,43例无癌栓脱落归为阴性组,19例显示癌栓脱落归为阳性组,癌栓脱落阴性组与阳性组比较,癌栓水平级别更低、癌栓构成更单一,比较差异均有统计学意义(P<0.05);两组的肿瘤大小、肺栓塞史及深静脉血栓史情况比较,差异均无统计学意义(P>0.05);经多因素Logistic回归分析,癌栓水平和癌栓构成是影响癌栓脱落的独立危险因素(P<0.05)。结论:Ⅲ级癌栓和混合性癌栓是术中癌栓脱落的独立危险因素,对于此类患者,可术前放置下腔静脉临时滤器,预防术中癌栓脱落导致的肺栓塞。Objective：In patients with renal cell carcinoma associated with inferior vena cava tumor thrombus,preoperative placement of the inferior vena cava temporary filter method to determine the risk factors for tumor embolus detachment,in order to assess the risk of tumor thrombectomy before surgery.Method：From January 2004 to June 2014,the clinical data of 62 cases of renal cell carcinoma with grade Ⅰ to Ⅲ inferior vena cava tumor thrombus were analyzed retrospectively.Preoperatively,the level of the tumor thrombus,whether the tumor thrombus and tumor thrombosis were mixed,whether there was a deep vein thrombosis,whether there was a recent history of pulmonary embolism,and the size of the primary tumor were determined.Preoperatively,temporary filters of the inferior vena cava were placed,and radical nephrectomy plus inferior vena cava thrombectomy were performed.The inferior vena cava angiography was performed after surgery.According to whether the tumor embolus was captured or not,patients were divided into positive and negative tumor-felling groups.The factors affecting the above mentioned factors affecting the shedding of tumor embolus were analyzed.Result：In the 62 patients,43 cases had no tumor embolus falling as the negative group,19 cased showed that the tumor embolus had fallen as the positive group.Compared the positive group,the level of tumor embolus was lower and the tumor embolus was more uniform,the difference was statistically significant（P〈0.05）.There was no significant difference in the diameter of primary tumor and history of pulmonary embolism in the two groups between the two groups（P〉0.05）.After multivariate Logistic regression analysis,the level of tumor embolus and the formation of tumor embolus were independent risk factors for the loss of tumor thrombus（P〈0.05）.Conclusion：Grade Ⅲ tumor embolus and mixed tumor embolus are independent risk factors for tumor embolus detachment during surgery.For these patients,temporary filters for the inferior vena cava can be pla

关 键 词：肾细胞癌 下腔静脉癌栓 临时滤器 肺栓塞 危险因素 

分 类 号：R737.11[医药卫生—肿瘤]