下腔静脉整段切除术治疗肾肿瘤伴下腔静脉癌栓完全性梗阻

Radical nephrectomy with venacavorectomy for the treatment of renal cancer with vena cava cancer thrombus

目的提高肾肿瘤根治术的治疗效果。方法报告应用下腔静脉整段切除术和右肾癌根治性切除术，治疗４例右肾肿瘤并下腔静脉癌栓完全性梗阻病人。４例下腔静脉癌栓均位于肝静脉平面以下。结果所有病人术后血尿素氮、肌酐水平无明显上升。１例因肿瘤肺转移于术后１年零３个月死亡，１例随访３年后失访，２例健在（分别为术后１年及１０个月）。结论无远处重要器官转移的伴有下腔静脉癌栓完全梗阻的肾肿瘤病人仍是积极手术治疗的指征。整段切除癌栓完全梗阻的下腔静脉，因包括左肾在内的血液回流已建立了良好的侧支循环，因而无需再行血管重建手术。

Objective To present the treatment of 4 cases of renal cancer with cancer thrombus in the vena cava. Methods Sectional venacavorectomy was perforemed together with radical nephrectomy for 4 cases of renal carcinoma with cancer thrombus in the vena cava,3 being renal cell carcinoma and 1 transitional cell pelvic carcinoma.The cancer thrombus was in the subhepatic segment of the vena cava in all the 4 cases. Results 1 patient died of lung metatasis 15 months after surgery;1 has been out of contact after 3 years' follow up;the other 2 life well of 1 year and 10 months respectively. Conclusions Section of the subhepatic portion of the vena cava during radical nephrectomy could be usually done safely for those cases of renal carcinoma with cancer thrombus in the subhepatice portion of the vena cava.