腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术

Pure laparoscopic radical nephrectomy and thrombectomy for renal tumors with renal vein and vena caval thrombus

目的探讨腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术的可行性。方法右肾占位病变患者2例。增强CT显示1例肿物部分延伸至肾静脉及腔静脉内．1例右肾静脉内可见充盈缺损并突入腔静脉内。均在全麻下行经后腹腔镜下根治性右肾切除及肾静脉、腔静脉取栓术。术中放置4个穿刺套管针，切断肾动脉后游离腔静脉及肾静脉，腔镜血管阻断钳部分阻断腔静脉，切开腔静脉取出瘤栓，缝合腔静脉，完整切除肾脏及瘤栓。结果2例患者的腔静脉瘤栓长度分别为0．3和1．0cm，均安全取出，术后恢复良好，5d出院。病理诊断分别为上皮样肾血管平滑肌脂肪瘤和肾透明细胞癌1～2级。术后随访5个月未见肿瘤复发和转移。结论对选择性肾肿瘤并肾静脉及腔静脉瘤栓患者行腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术安全可行。

Objective To evaluate the feasibility of using pure laparoscopic radical nephrectomy and thrombectomy to treat renal tumor with renal vein and vena caval thrombus. Methods Two cases of right renal tumor with renal vein and vena caval thrombus were reported. Contrast-enchanced CT showed renal tumor extended into renal vein and vena cava in 1 case, and filling defect was found in right renal vein and extended to vena cava in the other. Both patients received pure laparoscopic radical nephrectomy and thrombectomy through retroperitoneal approach. Four trocars were placed during the operation, and the renal artery was dissected before the vena cava was mobilized circumferentially above and below the renal vein, a laparoscopic vessel blockage clamp was used to partly occlude the vena cava containing the thrombus. The vena cava was repaired after the intact tumor thrombus was extracted. Results The tumor thrombus extended 0.3 cm and 1.0 cm above the renal vein, respectively. Both patients were discharged 5 d after operation. Pathological examinations showed that tumors were epithelioid renal angiomyolipoma and grade Ⅰ -Ⅱ clear cell carcinoma separately. Both patients were free of local recurrence and metastasis 5 months after operation. Conclusion Pure laparoscopic radical nephrectomy and thrombectomy for renal tumor with vena caval and renal vein thrombus is feasible in carefully selected patients.