完全后腹腔镜手术治疗右侧肾癌合并Mayo分级Ⅰ~Ⅱ级下腔静脉瘤栓可行性探讨(附11例报告)  

Pure retroperitoneal laparoscopic surgery for renal cell carcinoma combined with MayoⅠ-Ⅱinferior vena cava thrombus:experience from 11 cases

作　　者：周嘉乐 吴小荣[1] 陈伟[1] 蒋晨[1] 黄吉炜[1] 张进[1] 陈勇辉[1] ZHOU Jiale;WU Xiaorong;CHEN Wei;JIANG Chen;HUANG Jiwei;ZHANG Jin;CHEN Yonghui(Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,200127

出　　处：《现代泌尿生殖肿瘤杂志》2020年第3期133-138,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨完全后腹腔镜手术治疗右侧肾癌合并Mayo分级Ⅰ~Ⅱ级下腔静脉瘤栓的可行性与相关手术经验。方法回顾性分析2014年1月至2018年8月收治的11例右侧肾癌伴下腔静脉瘤栓患者的资料,男9例,女2例,平均年龄61.2岁,合并Ⅰ级瘤栓6例、Ⅱ级瘤栓5例,肿瘤平均大小68.7 mm。所有患者均于全麻下行完全后腹腔镜根治性肾切除术联合下腔静脉瘤栓取出术。结果本组11例患者手术均顺利完成,无术中或围手术期死亡病例,无术中中转开放病例。手术时间170~600 min,平均240 min。术中出血量100~2000 ml,平均术中出血量490.9 ml。所有病例术中均无瘤栓脱落,围手术期无肺栓塞症状。术后病理诊断为肾透明细胞癌7例(其中2例伴肉瘤样变),Ⅱ型肾乳头状癌3例,肉瘤样癌1例。术后随访8~56个月,平均随访时间34.2个月,其中4例因肿瘤转移死亡,3例在随访中发现转移而接受靶向药物治疗,目前均无肿瘤进展,4例在末次随访时存活且未发现肿瘤复发转移。结论完全后腹腔镜根治性肾切除术联合瘤栓取出术是治疗肾癌合并Mayo分级Ⅰ~Ⅱ级下腔静脉瘤栓的一种可选术式,但其临床疗效有待多中心、大样本研究进一步探索。Objective To report our experience of pure retroperitoneal laparoscopic radical nephrectomy(LRN)with thrombectomy in the management of right renal masses with levelⅠor levelⅡinferior vena cava(IVC)thrombus.Methods We performed a retrospective record review of 11 patients with levelⅠor levelⅡIVC thrombus who underwent LRN with thrombectomy using a pure retroperitoneal approach from January 2014 to August 2018.Results All 11 pure retroperitoneal laparoscopic procedures were successful,without open or hand-assisted conversion.The mean age and body mass index of the 11 patients(9 males and 2 female)were 61.2 years and 23.3 kg/m 2,respectively.Six patients had levelⅠthrombus and 5 had levelⅡthrombus.The mean tumor size was 68.7 mm(range 48 to 91).The mean operation time was 240 min(range,170-600 minutes),estimated blood loss was 490.9 ml(range,100 to 2000 ml)and hospital stay was 7 days(range,4 to 9 days).There was no intraoperative complication,but 3 postoperative complications(ClavienⅠ-Ⅱ)were found.During a mean follow-up period of 34.2 months(range,8-56),4 patients died of cancer progression or metastasis,3 patients received targeted therapy and the remained had been alive till the end of follow-up period.Conclusions In appropriately selected cases,pure retroperitoneal LRN and thrombectomy may be a safe and technically feasible alternative to open surgery in experienced hands with significant laparoscopic skills.

关 键 词：腹腔镜 肾细胞癌 瘤栓 瘤栓取出术 

分 类 号：R73[医药卫生—肿瘤]