腹膜后肿瘤手术并下腔静脉及肾静脉切除与重建

Resection and reconstruction of inferior vena cava and renal vein in surgical treatment of retroperitoneal tumours: a report of 11 cases

目的探讨复杂腹膜后肿瘤手术切除时对腹腔大血管的处理方法，以提高肿瘤切除率。方法总结了１９９０年～１９９７年手术切除腹膜后肿瘤２１９例中的１１例合并下腔静脉（ＩＶＣ）或肾静脉（ＲＶ）切除的经验。其中ＲＶ下ＩＶＣ切除５例，肝下ＩＶＣ及右肾切除３例，肝下ＲＶ上ＩＶＣ切除１例，左ＲＶ大部切除与左输卵管静脉吻合２例（１例合并ＩＶＣ切除）。结果随访半年本组无１例死亡，血尿素氮、肌酐及肾脏Ｂ超检查均在正常范围。结论（１）左ＲＶ有较多属支和恒定吻合干与周围静脉相连，可于左ＲＶ近心端结扎，如需切除部份ＲＶ，则至少保留一个ＲＶ属支（通常为左性腺静脉）以维持循环；（２）ＩＶＣ切除一般不需行血管重建，但如肾静脉血流受阻，则应行血管重建，至少保证一个肾脏血液回流。

Objective To improve the surgical resection rate of complicated retroperitoneal tumors which depends on handling of celiac major blood vessel.Methods 219 retroperitoneal tumours were resected from 1990 to 1997. Eleven of them were resected in combination of resections and reconstructions of inferior vena cavas (IVC) and renal veins (RV).IVC below RV was resected in 5 cases, IVC below liver with resections of right kidney in 3 cases, IVC above RV in 1 case, major partial resections of left RV with anastomosis to left ovarian vein in 2 cases, and 1 of them with IVC resection.Results Follow up showed transient bilateral lower limbs edema in 3 cases.The values of blood urea nitrogen and creatinine were normal after operations, no changes were found in the kidneys under ultrosonic examination.Conclusion As the left renal vein has many branches and constant anastomotic branches that connect with peripheral veins, it can be ligated proximally; and it even can be resected when at least one of its branches (rountinely lift sexual gland vein) can be kept to maitain the blood circulation. Reconstruction of IVC and RV is usually not necessory after the resection of IVC, unless the bilateral renal veins were obstructed.