北京大学学报（医学版）2018，Vol.50Issue(1)：183-187,5.DOI:10.3969/j.issn.1671-167X.2018.01.031
腔静脉节段切除术在处理侵犯腔静脉的肾肿瘤瘤栓中的应用
Segmental vena cava resection for the treatment of renal tumor with invading tumor thrombus
叶剑飞 1马潞林 1赵磊 1王国良1
作者信息
- 1. 北京大学第三医院泌尿外科,北京 100191
- 折叠
摘要
Abstract
Objective: To investigate the safety and perioperative experience of the segmental resection of the vena cava. Methods: From May 2015 to July 2017, 92 renal tumor patients with venous tumor thrombus were treated in Peking University Third Hospital, of whom 17 underwent nephrectomy with resection of the invaded vena cava for renal tumor with tumor thrombus invading vena cava. The preoperative features included that 15 patients were male and 2 female, the mean age was (59. 2 ±12.9) years (31-84 years), 6 cases were left sided and 11 right sided,and the mean diameter of the renal tumor was (9.1 ±3.7) cm (3-14.5 cm). Results: In this group of 17 cases, 5 patients underwent resection of the vena cava via laparoscopy (including 2 open conversions),and 12 via open procedures (including 2 cardiopulmonary bypasses). The mean operation time was (430.4 ± 120. 7) min (284-694 min) and the mean intraoperative blood loss was (2 918. 8 ±2 608. 2) mL (300-10 000 mL). The vena cava from the bottom to the top was transected. The median length of the tumor thrombus in the vena cava was 10 cm (3-21 cm). Postoperative complications were found in 11 patients, including grade I in 1 case,grade Ⅱ in 7 cases, grade Ⅳ in 2 cases and grade V in 1 case according to the Clavien system. The median postoperative creatinine was 116 μmol/L (79-645 μmol/L) with 2 patients needing dialysis. The postoperative pathology revealed that renal clear cell carcinoma in 10 cases, papillary carcinoma in 5 cases, urothelial carcinoma in 1 case and fusiform cell sarcoma in 1 case. During the median follow-up of 8 (1-28 ) months,1 patient died during perioperative period,1 patient died from multiple metastasis in 9 months postoperatively, 3 patients found distant metastasis and 2 cases remained lower extremity edema after operation. Conclusion: The segmental resection of the vena cava may be a good choice for non-metastatic renal tumors with tumor thrombus invading vena cava. The short term follow-up results revealed a satisfactory safety and feasibility.关键词
肾肿瘤/腔静脉/血管肿瘤/瘤栓/血管外科手术Key words
Kidney neoplasms/Venae cavae/Vascular neoplasms/Tumor thrombus/Vascular surgical procedure分类
医药卫生引用本文复制引用
叶剑飞,马潞林,赵磊,王国良..腔静脉节段切除术在处理侵犯腔静脉的肾肿瘤瘤栓中的应用[J].北京大学学报（医学版）,2018,50(1):183-187,5.
