Foley尿管在肾癌合并下腔静脉癌栓中的应用

Use of Foley catheter in renal carcinoma with inferior vena cava tumor thrombus

目的探讨应用Foley尿管在肾癌合并下腔静脉癌栓肾癌根治术时取出癌栓的效果。方法2001年10月～2008年6月收治肾癌合并腔静脉癌栓患者15例，肾癌根治术术中应用Foley尿管取出癌栓11例，其中Ⅲ型癌栓5例，Ⅳ型癌栓6例。术中先游离肾脏及肾动、静脉，结扎肾动脉，游离出对侧肾静脉及癌栓上下的腔静脉并阻断，在患。肾对侧的腔静脉壁纵行剪开3～4cm，插入Foley尿管，气囊内注入20mL生理盐水，用Foley尿管将癌栓牵出腔静脉外，取下患肾和癌栓，阻断腔静脉进行缝合。结果11例手术顺利，全部将癌栓完整取出，手术时间3～5h，出血量2.0～1000mL。结论肾癌合并腔静脉癌栓在肾癌根治术中用Foley尿管取出癌栓可避免开胸或体外循环，减少手术损伤，疗效良好。

Objective To summarize writers＇ experience of using Foley catheter in radical nephrectomy in patients of renal carcinoma with inferior vena cava （IVC） tumor thrombus. Methods From Oct. 2001 to Jun.2008, 1~5 patients were admitted because of renal carcinoma with IVC tumor thrombus. Among them 11 patients were treated with radical nephrectomy and the tumor thrombus in IVC were taken out with Foley catheter during operation. 5 patients had type Ⅲ thrombus and 6 had type Ⅳ thrombus. During the operation, the diseased kidney was liberated fully and renal artery was ligate-d first. Then the renal vein of the other kidney and IVC were exposed clearly, the renal vein of the contralateral kidney and IVC below thrombus were blocked temporarily, an opening of 3~4 cm was made on the IVC wall opposite to diseased kidney and a Foley catheter was inserted into IVC. The balloon of catheter was inflated with 20mL saline, then the catheter was withdrawn slowly with thrombus pulled out. The renal vein of diseased kidney was cut off from IVC with 2mm IVC wall, the kidney and thrombus were removed and the IVC were sutured with 5-0 Prolene sutures. Results All 11 operations were successful and all the thrombus were intact, operation time 3~5 hr, blood loss 200--1000 mL. Conclusion The use of Foley catheter in radical nephrectomy in patients of renal carcinoma with IVC tumor thrombus is a simple and effective without thoracic incision and extracorporeal circulation.