肾癌合并Ⅲ型下腔静脉癌栓切除术

Surgical management of renal cell carcinoma with level Ⅲ inferior vena cava tumor thrombus

目的探讨在TempofilterⅡ腔静脉滤器保护下行肾癌Ⅲ型下腔静脉癌栓切除的安全性及手术方法。方法回顾性分析2006～2009年治疗的7例肾细胞癌合并Ⅲ型下腔静脉癌栓患者的临床资料,术中先在数字减影血管造影下经右侧颈内静脉穿刺放置TempofilterⅡ腔静脉滤器于下腔静脉内癌栓近心端,然后在全肝血流阻断下切开肝下下腔静脉,直视下切除癌栓。结果 7例患者术前均经CT血管造影或磁共振血管造影明确诊断,7例均手术成功,6例癌栓与下腔静脉无明显浸润,1例癌栓浸润下腔静脉侧壁行下腔静脉成形。全组无肺栓塞(PE)发生,无围手术期死亡。结论 TempofilterⅡ腔静脉滤器保护下肾癌下腔静脉癌栓切除是安全的,可有效预防PE的发生,术中全肝血流阻断在无血状态下切开下腔静脉是完全切除癌栓的关键。

Objective To investigate the safety and surgical methods of resection the renal cell carcinoma with level Ⅲ inferior vena cava tumor thrombus under the protection of Tempofilter Ⅱ vena cava filter.Methods Retrospectively analyse the data of 7 cases with renal cell carcinoma combined with level Ⅲ inferior vena cava tumor thrombus from 2006 to 2009.During the operation,at first,Tempofilter Ⅱ vena cava filter was placed through right carotid vein in proximal end of tumor thrombus in the inferior vena cave,then totally block the liver blood flow,incise the inferior vena cava below the liver,and resect the tumor thrombus directly.Results Seven cases were diagnosed by CTA or MRA,and all were operated successfully.One patient with vena caval invading tumor thrombus was performed vena cava angioplasty but the other 6 cases didn't present vena caval invading tumor thrombus.There was no pulmonary embolism occurred,and no perioperative death.Conclusion Resection of renal cell carcinoma with inferior vena cava tumor thrombus under the protection of Tempofilter Ⅱ vena cava filter is safe,can effectively prevent the occurrence of pulmonary embolism,during the operation,totally block the hepatic blood flow and open the IVC in the state of absence of blood is the key to entirely resect the tumor thrombus.