肾癌伴腔静脉癌栓的手术治疗

Surgical Treatment of Renal Cell Carcinoma Complicated by Tumor Thrombi of Inferior Vena Cava

目的:探讨手术治疗肾癌合并腔静脉癌栓患者的预后。方法:回顾分析2003年12月～2009年12月我院12例经手术及病理证实的肾癌合并腔静脉癌栓患者的资料,其中男性10例,女性2例,中位年龄62(42～76)岁。肾静脉癌栓6例,左侧2例,右侧4例;下腔静脉癌栓Ⅱ级(肝下型)3例,Ⅲ级(肝内型)3例。12例患者术前均经CT或MRI检查明确诊断肾癌合并腔静脉癌栓。结果:12例患者接受肾癌根治术的同时行静脉癌栓切除,术后9例患者得到随访,随访时间6～72个月,无瘤生存1～3年4例,生存5年以上的4例,1例术后6个月死于肿瘤复发。结论:CT和MRI对肾癌伴下腔静脉癌栓诊断率较高,可准确判断癌栓位置,对无淋巴结和远处转移者,在行肾癌根治术的同时行下腔静脉癌栓取出术是治疗肾癌合并静脉瘤栓积极有效的治疗方法。

Objective： To summarize our experience on surgical treatment of renal cell carcinoma with tumor thrombi of inferior vena cava. Methods： This retrospective study involved 12 patients with renal cell carcinoma complicated with tumor thrombi of inferior vena cava. Radical nephrectomy plus vena cava thrombus removal were conducted in our hospital during the period from December 2003 to December 2009. Results： Final diagnosis of renal carcinoma complicated by tumor thrombi of vena cava was made in all 12 patients following preoperative CT scan and MRI examination. Tumor thrombi of renal vein or inferior vena cava were found in all the patients, with 2 of the 12 cases having the tumor embolus of left renal vein, 4 having tumor embolus of right renal vein, and 6 suffering the tumor embolus of vena cava （3 with sub-hepatic vena cava and the other 3 with intra-hepatic vena cava）. All patients underwent radical nephrectomy and thrombectomy concurrently. Nine of the 12 patients were followed up for a period ranging from 6 to 72 months after surgery. Four of the 12 patients survived disease-free for 1 to 3 years, 4 survived disease-free for more than 5 years, and 1 died with tumor recurrence 6 months after surgery. Conclusion： Radical nephrectomy plus removal of vena cava thrombus can achieve a long-term survival for patients with renal cell carcinoma and vena cava thrombi and without regional and distant metastases.