腔静脉瘤栓延伸至右侧心腔的诊断和外科治疗

Diagnosis and surgical treatment of intravenous tumor embolus extending through inferior vena cava into the right cardiac cavities

目的肾脏和妇科肿瘤经下腔静脉直接延伸到右心房非常少见，本文探讨下腔静脉内瘤栓延伸至右心房的诊断与外科治疗。方法回顾我院2001年1月至2008年7月诊治的4例腔静脉内瘤栓延伸至右心房患者的临床资料。子宫平滑肌瘤3例，采取分期或同期手术。其中2例行分期手术，先行常规全麻中低温体外循环下心脏肿物切除术，然后二期切除子宫、附件及子宫病变组织，进行盆腔清扫术；1例行同期手术。肾透明细胞癌1例，同期切除肾脏肿瘤，并于全麻深低温停循环下切除下腔静脉瘤栓。结果4例手术无死亡，无围术期并发症。随访3个月-5年，患者均存活，无肿瘤复发。结论明确诊断，提高对肿瘤延伸侵入腔静脉及右心房的警惕性，体外循环直视下行心脏内肿物切除术，多科协作，同期或分期切除原发病变，结合综合治疗，可获满意的效果。

Objective Renal tumor and gynecological tumor invading into inferior vena cava and extending to the right cardiac cavities is quite uncommon, we report the experience of diagnosis and surgical treatment of intravenous tumor embolus extending through inferior vena eava into the right cardiac cavities. Methods From Junuary 2001 to May 2008,4 patients with intravenous tumor embolus extending through inferior vena cava into right cardiac cavity were treated in PUMC Hospital. Three cases were leiomyomatosis. Two patients＇ operation was performed by stages, firstly removed turner in the right cardiac cavities using eardiopulmonary bypass under mid-hypothermia, and, postoperatively 3 - 4 weeks, total abdominal hysterectomy with bilateral salpingo-oophorectomy including the tumor mass was performed. The other patient＇s tumor was resected at one time. One case is renal clear cell carcinoma, The urologist performed abdominal nephrectomy and then cardiac surgeon resected tumor embolus using cardiopulmonary bypass under deep hypothermic total circulatory. Results The four patients were uneventful recovery, there was no death or any serious perioperative complications. Following up of 3 months to 4 years showed no tumor recurrence after the operation. Conclusion Confirmed diagnosis, the tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected among patients with renal cell carcinoma and multiple hyste romyoma are all critical for the treatment . Successful therapy for intravenous tumor embolus is dependent on total one or two-stage surgical excision of the tumor and muhi-department cooperation and combined therapy.