下腔静脉取栓及血管重建术在肾癌并下腔静脉癌栓术中的应用(附7例报告)

The clinical application of inferior vena cava tumor embolthrombectomy and vascular reconstruction in radical nephrectomy complicated by tumor emboli

目的总结与探讨肾癌伴下腔静脉癌栓手术治疗的经验和临床应用价值。方法回顾性分析2006年4月～2010年10月行R CC根治术中联合IVC取栓、血管重建术7例患者的临床资料:男性6例,女性1例,中位年龄52岁;Mayo Clinic的IVC癌栓分类法分为:0级0例,Ⅰ级1例,Ⅱ级2例,Ⅲ级3例,Ⅳ级1例。病理分期(Robson分期):Ⅲ期5例,Ⅳ期2例。结果 7例均成功行肾癌根治性切除、下腔静脉癌栓取出及即时下腔静脉修复重建。其中,5例行单纯连续缝合IVC切口修复;Ⅲ期中IVC壁缺损较大的两例分别用自体肝镰状韧带补片修复一例,行端端吻合一例。无围手术期死亡及严重并发症发生。随访5个月～5年,4例于术后8～9个月肿瘤复发死亡。2例3年无瘤生存。1例失访。结论对无淋巴结和远处转移的肾癌伴下腔静脉癌栓患者,在行RCC根治性切除的同时,积极地进行联合IVC取栓、切除受侵静脉壁和IVC重建,能够提高远期存活率。并指出:普外科、泌尿外科、血管外科、心脏外科、麻醉科等多学科的密切合作对保证此手术的成功至关重要。

[ Objective ] To summarize and explore the experience and the clinical application value of the treatment of renal cell carcinoma （RCC） with inferior vena cava （IVC） tumor emboli. [ Methods ] From Apr 2006 to Oct 2010, the clinical information of 7 patients of radical nephrectomy combined with inferior vena cava tumor emboli thrombectomy and the vein reconstruction was retrospectively analyzed. 6 were male and 1 female, the median age was 52 years. The tumor emboli were graded according Mayo Clinic： level 0 in 0 cases, level I in 1, level II in 2, level III in 3, level IV in 1. Robson clinical stages： stage m in 5 cases, stage 1V in 2. [ Results ] 7 patients were successfully performed the operation of radical nephrectomy combined with inferior vena cava tumor emboli thrombectomy and the vein reconstruction. 5 cases of 7, the IVC incision were sutured by simple suture successively. 2 cases of 7, the defect of IV.C was serious, 1 received vascular repair with liver falciform ligament patch, lvascular anastomosis. No perioperative death or serious complications occurred in the group. All the patients had been followed up after surgery except that 1 was lost visit. 4 patients died of tumor recurrence and metastasis at the 8-9 months after surgery and 2 were survival during the follow up of 60 months. [ Conclusion] Radical nephrectomy combined with inferior vena cava tumor emboli thrombectomy and vascular resection and reconstruction can improve long-term survival significantly, and emphasize the close cooperation including general surgery, urology, vascular surgery, cardiosurgery and anesthetist were very important and the key of operating successfully.