肾血管平滑肌脂肪瘤合并下腔静脉瘤栓的开放保肾策略  

Open nephron-sparing surgery strategy for renal angiomyolipoma with vena cava thrombus

作　　者：周嘉乐 吴小荣[1] 黄吉炜[1] 陈伟[1] 陈勇辉[1] 薛蔚[1] Zhou Jiale;Wu Xiaorong;Huang Jiwei;Chen Wei;Chen Yonghui;Xue Wei(Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong 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科,上海200127

出　　处：《中华泌尿外科杂志》2025年第1期17-22,共6页Chinese Journal of Urology

基　　金：上海市卫健委重中之重研究中心B类(2023ZZ02014)。

摘　　要：目的探讨开放肾部分切除术治疗肾血管平滑肌脂肪瘤(AML)合并下腔静脉瘤栓的手术策略及临床疗效。方法回顾性分析上海交通大学医学院附属仁济医院2014年10月至2022年12月采用肾部分切除术治疗5例AML合并下腔静脉瘤栓患者的临床资料。男2例,女3例;年龄33~45岁,中位年龄37岁。所有患者均在常规体检中发现。右侧4例,左侧1例。肾内原发肿瘤直径3.0~7.0 cm,中位直径5.5 cm;下腔静脉内瘤栓长度1.0~6.0 cm,中位长度1.5 cm。其中2例行工作台肾部分切除术联合下腔静脉瘤栓取出术及自体肾移植术(工作台手术组),3例行开放肾部分切除术联合下腔静脉瘤栓取出术(原位保肾手术组)。工作台手术组手术方法:患者先在腹腔镜下行患侧肾切除术联合下腔静脉瘤栓取出术,后延长切口取出患肾,行工作台肾部分切除术,取净患肾内肿瘤及肾静脉内瘤栓后行髂窝自体肾移植术。原位保肾手术组手术方法:游离并显露患肾、患侧肾动静脉、下腔静脉及对侧肾静脉;分别阻断下腔静脉远心端、对侧肾静脉、下腔静脉近心端及患侧肾动脉。在肾静脉中段打开静脉壁,逐步拖出瘤栓。根据事先标记的肿瘤边界,钝锐性交替,结合吸引器吸除的方式逐步取净肾内瘤体后逐层缝合创面。分析患者围手术期情况、并发症及随访结果。结果5例手术均顺利完成,手术时间100~450 min,中位手术时间200 min;术中出血量100~600 ml,中位出血量150 ml;原位保肾手术组肾动脉阻断时间28~41 min,中位阻断时间34 min。所有患者术后均顺利出院,围手术期均无严重并发症(Clavien-DindoⅢ~Ⅳ级)发生。5例患者术后病理均为AML,均无上皮样成分。术后患者随访12~90个月,中位随访时间24个月。5例患者均未见肿瘤复发或转移,术后定期随访肾功能,均未出现明显肾功能减退。结论AML合并静脉瘤栓是棘手的临床问题,原位开放肾部分切除�ObjectiveTo explore the surgical strategies and clinical efficacy of open partial nephrectomy in the treatment of renal angiomyolipoma(AML)with inferior vena cava tumor thrombus.MethodsA retrospective analysis was conducted on the clinical data of 5 patients with renal AML and inferior vena cava tumor thrombus who underwent partial nephrectomy at Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from October 2014 to December 2022.There were 2 male and 3 female patients,with a median age of 37 years,ranged from 33 to 45 years.All patients were identified during routine physical examinations.Four patients presented with right-sided lesions,while one had a left-sided lesion.The diameter of the primary tumor within the kidney ranged from 3.0 to 7.0 cm,with a median diameter of 5.5 cm.The length of the tumor thrombus within the inferior vena cava ranged from 1.0 to 6.0 cm,with a median length of 1.5 cm.Among them,2 patients underwent laparoscopic nephrectomy combined with extracorporeal workbench tumor resection and autologous kidney transplantation(the workbench surgery group),while 3 patients underwent open in-situ partial nephrectomy combined with removal of inferior vena cava tumor thrombus(the in-situ nephron-sparing surgery group).The surgical method of the workbench surgery group:The patients first underwent laparoscopic nephrectomy on the affected side combined with inferior vena cava tumor thrombus removal,then the incision was extended to remove the affected kidney,and table partial nephrectomy was performed.After completely removing the tumor and tumor thrombus within the affected kidney and renal vein,autologous kidney transplantation was performed in the iliac fossa.The surgical method of the in-situ kidney preservation surgery group:The affected kidney,renal artery and vein on the affected side,inferior vena cava,and contralateral renal vein were dissected and exposed.The distal end of the inferior vena cava,the contralateral renal vein,the proximal end of the inferior vena cav

关 键 词：肾肿瘤 血管平滑肌脂肪瘤 下腔静脉 瘤栓 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]