改良肝松解技术处理肾癌肝内下腔静脉瘤栓的临床研究

Modified liver mobilization technique in the management of renal cell carcinoma with intrahepatic inferior vena cava thrombosis

目的 探讨改良肝松解技术处理肾癌合并肝内下腔静脉瘤栓的安全性和疗效。方法2006年7月至2010年8月采用改良肝松解技术治疗肾癌伴肝内下腔静脉瘤栓患者10例。男7例，女3例。年龄36—71岁，平均49岁。临床分期T1aN0M0。使用克氏无创阻断钳阻断肝上下腔静脉，配合使用肝门阻断带，切除下腔静脉瘤栓。结果本组10例手术均顺利完成，平均手术时间300min，术中平均出血量800ml，平均输血650ml。住院时间10～15d，平均13d。无气胸、肺炎、心肌梗死、术后大出血、邻近脏器损伤等严重并发症出现。随访1个月～4年，无复发转移。结论术中使用克氏无创阻断钳阻断肝上下腔静脉，有助于切除肾癌伴肝内下腔静脉瘤栓，可避免开胸手术，减小手术创伤。

Objective To report the modified liver mobilization technique in management of renal cell carcinoma with intrahepatic inferior vena cava thrombus. Methods 10 cases （7 men and 3 women at the average age of 49 years） of renal cell carcinoma with intrahepatic inferior vena cava thrombus were re- viewed. The operations were carried by using father clamp to control inferior vena cava, combined with he- patic portal blocking. Results There was no postoperative complication. The average blood loss was 800 ml. The mean hospital stay was 13 days. The time of follow-up ranged from 1 to 48 months. Conclusions The technique of using father clamp to control suprahepatic inferior vena cava combined with hepatic portal blocking is feasible for the treatment of the renal cell carcinoma with intrahepatic inferior vena cava thrombosis.