原位自体肾移植联合下腔静脉切除重建在腹膜后肿瘤中的应用  

Application of orthotopic autologous renal transplantation combined with inferior vena cava resection and reconstruction in retroperitoneal tumor

作　　者：庞北川 张娜 杨冲 廖玉波 黄良 杨文昊 袁承祥 张宇 PANG Beichuan;ZHANG Na;YANG Chong;LIAO Yubo;HUANG Liang;YANG Wenhao;YUAN Chengxiang;ZHANG Yu(School of Medicine,University of Electronic Science and Technology of China,Chengdu 610054,P.R.China;Organ Transplantation Center,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,P.R.China;The 5th Assignment Outpatient Department,Western Theater General Hospital,Chengdu 610083,P.R.China;Clinical Medicine College,Chengdu Medical College,Chengdu 610500,P.R.China)

机构地区：[1]电子科技大学医学院,成都610054 [2]电子科技大学附属医院•四川省人民医院器官移植中心,成都610072 [3]西部战区总医院第五派驻门诊部,成都610083 [4]成都医学院临床医学院,成都610500

出　　处：《中国普外基础与临床杂志》2022年第8期1018-1023,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省医学科学院(四川省人民医院)临床研究及转化基金(项目编号:2017LY04)。

摘　　要：目的探讨原位自体肾移植联合下腔静脉(inferior vena cava,IVC)切除重建在腹膜后肿瘤中的应用及临床疗效。方法回顾性分析1例复杂腹膜后肿瘤患者的临床资料。腹部CT检查提示肿瘤起源于IVC,侵及肝后IVC及双侧肾静脉主干。术中超声探查可见IVC及双肾静脉主干内机化血栓形成。阻断左侧肾静脉后,术中行超声探查及超声造影(contrast-enhanced ultrasound,CEUS)前后对比未见明显血流动力学改变。结果术中完整切除左肾静脉并缝扎断端,取出右肾静脉内机化血栓后,成功行原位自体右肾移植联合IVC切除重建。患者术后恢复良好,复查CT检查提示重建的人工IVC通畅,双肾血管彩色多普勒超声检查提示血流灌注良好,未见回流障碍。术后予以口服利伐沙班抗凝治疗,患者于术后19 d出院,术后病理学检查结果提示为IVC平滑肌肉瘤(inferior vena cava leiomyosarcoma,IVCL)。结论原位自体肾移植联合IVC切除重建治疗复杂腹膜后肿瘤是安全可行的,左侧肾静脉可视术中情况予以结扎离断,但需联合术中超声(造影)综合评判决定。Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava(IVC)resection and reconstruction in retroperitoneal tumor.Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively.Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks.Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks.After blocking the left renal vein,no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound.Results After complete removal of the left renal vein and suture of the severed end,the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus.The patient recovered well after surgery,and a repeat CT showed that the reconstructed artificial IVC was patent,and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return.The patient was given oral rivaroxaban anticoagulant therapy after operation,and discharged at 19 days after operation.The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma.Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible,and the left renal vein can be ligated and dissected intraoperatively,but a comprehensive evaluation with intraoperative ultrasound(imaging)is required.

关 键 词：腹膜后平滑肌肉瘤 原位自体肾移植 下腔静脉切除重建 人工血管 超声造影 

分 类 号：R735.4[医药卫生—肿瘤]