手术治疗肾癌合并下腔静脉瘤栓

Surgical treatment of renal cell carcinoma with inferior vena cava thrombus

目的评价手术治疗肾细胞癌合并下腔静脉瘤栓的疗效。方法回顾分析38例经手术治疗的肾细胞癌合并下腔静脉瘤栓患者的临床资料。结果 38例患者中,男28例,女10例,平均年龄56岁;右肾癌伴腔静脉瘤栓31例,左肾癌伴腔静脉瘤栓7例;Ⅰ级瘤栓8例,Ⅱ级24例,Ⅲ级3例,Ⅳ级3例。所有患者均行肾癌根治切除及取瘤栓术,其中35例下腔静脉阻断下切除下腔静脉瘤栓,3例瘤栓达右心房,在体外循环腔静脉心房分流下取瘤栓。围手术期无死亡病例。随访6～114个月,平均41个月,21例无瘤生存(55.2%),2例复发转移带瘤生存(5.2%),13例肿瘤转移死亡(34.2%),2例失访。结论没有转移的肾细胞癌合并下腔静脉瘤栓如能完整切除,并非手术禁忌和愈后不良的因素。

Objective Evaluate the effect of surgical treatment of renal cell carcinoma with inferior vena cava thrombus.Methods 38 RCC patients with inferior vena cava thrombus undertaken surgery in our hospital between 1999 and 2009 were included.There were 8 perirenal thrombus （level Ⅰ）,24 infrahepatic thrombus （level Ⅱ）,3 retrohepatic thrombus （level Ⅲ） and 3 supradiaphragmatic thrombus into right atrium extension （level Ⅳ）.Results Thirty-five patients underwent radical nephrectomy and vena caval thrombectomy.Three supradiaphragmatic thrombectomies were done under IVC-atrial bypass.There was no operative mortality,and the overall survival at 5-yr was 55.2%.Conclusions Nonmetastatic RCC with extension into the IVC is a potentially curable condition provided complete removal can be achieved.