多体位全腔镜治疗左肾癌伴下腔静脉癌栓(MayoⅢ)1例  

One case of left renal cell carcinoma with inferior vena cava tumor thrombus(MayoⅢ)treated with pure laparoscopic surgery in multi body positions

作　　者：安森胜 闵勇正 宋华 AN Sensheng;MIN Yongzheng;SONG Hua(Department of Urology,the 960th Hospital of PLA,Jinan,250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院泌尿外科,济南250031

出　　处：《临床泌尿外科杂志》2023年第10期803-806,共4页Journal of Clinical Urology

摘　　要：探讨肾癌伴下腔静脉癌栓的诊断和治疗进展,特别是外科手术方式的探讨。结合文献分析对1例左肾癌伴MayoⅢ型下腔静脉癌栓的诊断和治疗进行回顾性分析,该患者术前经腔静脉B超、CT以及三维重建明确诊断。行多体位全腔镜肾癌根治性切除同时行下腔静脉取栓术,该患者术后随访1年未出现肿瘤转移。肾癌伴下腔静脉癌栓诊疗难度较大,特别是MayoⅢ型以上下腔静脉肾癌癌栓的处理,左侧肾癌伴下腔静脉癌栓难度更大。对无淋巴结和远处转移的患者应积极手术治疗,癌栓侵入下腔静脉的高度及有无侵犯静脉壁的判断对手术方式的选择十分重要;术后综合治疗往往可以改善患者的预后;多学科团队协作甚至是多个中心的协作模式为疑难危重病例的治疗提供了一种新的模式。To explore the progress of diagnosis and treatment of renal cell carcinoma(RCC)with inferior vena cava(IVC)tumor thrombus(MayoⅢ),especially the mode of surgery.We performed a retrospective analysis on the diagnosis and treatment of one case of renal carcinoma with IVC tumor thrombus(MayoⅢ)combined with the literature review.In this case,the diagnosis was clearly established by B-ultrasound and CT of the vena cava as well as three-dimensional reconstruction before surgery.Pure laparoscopic surgery of renal carcinoma and thrombectomy of the IVC in multi body positions was performed,and this patient did not show tumor metastasis during the postoperative follow-up period of one year.The diagnosis and treatment of RCC with IVC tumor thrombus is difficult,especially for the management of patients with Mayo typeⅢand above IVC tumor thrombus,and left RCC with IVC tumor thrombus is more difficult.Patients without lymph node or distant metastasis should be treated aggressively with surgery,and the height of the invasion of the tumor thrombus into the IVC and the judgment of the presence or absence of invasion into the venous wall are important for the choice of surgical approach.Comprehensive postoperative treatment can often improve the prognosis of patients,and the multi-disciplinary treatment(MDT)or even the cooperation of multiple centers provides a new model for the management of difficult critical cases.

关 键 词：肾癌 下腔静脉癌栓 诊断与治疗经验 全腔镜手术 文献分析 

分 类 号：R737.11[医药卫生—肿瘤]