肾癌下腔静脉癌栓的诊治及预后(附12例报告)

DIAGNOSIS、TREATMENT AND PROGNOSIS OF RENAL CELL CARCINOMA ACCOMPANIED BY VENA CAVA EMBOLUS: A REPORT OF 12 CASES

目的:提高肾癌下腔静脉癌栓的诊治水平。方法:回顾分析12例经手术及病理证实的肾癌下腔静脉癌栓患者的资料。结果:12例腔静脉癌栓均为膈下型,其中肾静脉型1例(8.3%),肝下型9例(75%),肝内型2例 (16.7%),无膈上型。彩超诊断腔静脉癌栓的准确率为66.7%(8/12),假阴性16.7%(2/12)。CT准确率83.3%(10/ 12),假阴性16.7%(2/12)。MRI准确率100%。术后3例失访,4例死于全身衰竭和肝转移,平均存活时间22个月,余 5例均健在,存活时间6-38个月,未见肿瘤转移征象。结论:MRI和彩色多普勒超声是目前诊断肾细胞癌伴静脉癌栓的较好方法。对无淋巴结和远处转移者,应采取积极手术的态度,手术方式取决于癌栓水平。

Objective: To improve the diagnosis and treatment level of renal cell carcinoma (RCC) accompanied by vena ca-va cancer embolus. Method: The clinical data of 12 patients of RCC diagnosed by operation and pathology were analyzed retrospectively. Results: The types of the vena cava cancer emboli were all subphrenic, renal vein accounted for 1 case (8.3%), subhepatic vena cava 9 cases (75 % ) and intrahepatic vena cava 2 cases (16.7%) . The accuracy rate of diagnosis of RCC with vein cancer embolus by means of color ultrasonograph, CT or MRI were 66.7% (8/12), 83.3% (10/12) and 100% separatively.The false negative rate of uitrasonograph, CT were 16.7% (2/12) and 16.7% (2/12) .4 patients died of systemic failure and hepatic metastasis. The average living time of the other 22 cases was twenty - two months.5 patients are still allive range from 6 months to 36 months with no enidence of metastasis. Conclusion: MRI and color ultrasonograph are the good measure tl detect RCC with inferior vena cancer emboli. It is recommnded that we should perform the operation in case of RCC without lymphatic or distal metastasis.The operation mode are determined mainly by the location of cancer embolo.