肾癌腔静脉癌栓20例诊治体会

Diagnosis and treatment experience of 20 cases of renal tumor with vena cava thrombus.

目的提高肾肿瘤合并下腔静脉癌栓的诊治水平。方法收集我院自1996年1月至2006年2月收治的20例肾癌合并腔静脉癌栓患者临床资料并进行随访分析。结果术前影像学诊断均无区域淋巴结或远处转移，通过超声、CT或MRI明确有腔静脉癌栓，膈上型1例；膈下型19例，其中肾静脉型11例，肝下型5例，肝内型3例。19例患者手术成功，1例术中死亡。术后病理分期（Robson分期）ⅢA期19例，ⅢC期1例。术后病理透明细胞癌17例，孔头状腺癌2例，血管平滑肌瘤1例。18例获得术后随访4～70月，平均38个月，2例分别于术后18、23个月因癌死亡，16例无瘤生存。结论手术是肾癌合并腔静脉癌栓的有效治疗方法，提高手术技巧和围手术期处理可增加手术的安全性。

Objective To improve the diagnosis and treatment of renal tumor with vena cava thrombus, Methods The clinical data of 20 cases of renal tumor with vena cava thrombus undergoing the radical nephrectomy plus tumor thrombus removal from Jan 1996 to Feb 2006 were analyzed retrospectively, Results Tumor thrombus within renal vein in 11 cases and 5 within infrahepatic vena cava.3 cases within intrnhepatic and 1 within supra- phrenic vena cava, 19 cases underwent successful operation and 1 case died during the operation. Postoperative pathological staging （Robson staging） showed IIA in 19 cases and IIIC in 1 case. The pathological examination showed clear-cell carcinoma in 17 cases .in papillary adenocarcinoma 2 cases and in vascular leiomyoma 1 case, 18 patients were followed up for 4 - 70 months after sugery with average month of 38.2 cases died of cancer after 18 and 23 months. 16 patients survived with disease-free, Conclusion Radical nephrectomy plus vena cava thrombus removal is a good and effective choice for the patient of renal tumor with vena cava thromhus. The improvement of the skill of the operation and the management of the perloperatlon can enhance the safety of the operation .