肾细胞癌合并腔静脉癌栓诊治体会(5例报告并文献复习)

Clinical experience about management of renal cell carcinoma with inferior vena cava tumor thrombus( report of 5 cases and literature review)

目的:探讨肾细胞癌合并腔静脉癌栓患者临床特点、诊断、综合治疗原则。方法:回顾性分析我院收治的5例肾细胞癌合并腔静脉癌栓患者临床资料并文献复习。其中3例接受开放肾癌根治性切除+癌栓取出术,1例接受腹腔镜下肾癌根治性切除+癌栓取出术,1例行靶向药物治疗。结果:4例手术均成功,手术平均时间213.7 min(135~315)min,术中平均出血量1 650.0 ml(600~3 500)ml,术后病理学诊断均为肾透明细胞癌,术中、术后未出现明显并发症,平均随访时间为12.2(5~30)个月,影像学复查未见明显复发、远处转移表现。结论:肾细胞癌合并腔静脉癌栓患者治疗上以根治性手术为主,条件合适患者可采用腹腔镜等微创手术方式,术前充分评估,术中多学科合作、严密监测、预防癌栓脱落,术前采用新辅助靶向药物治疗可能降低癌栓等级、手术难度。

Objective： To discuss the clinical experience about management of renal cell carcinoma with inferior vena cava tumor thrombus.Methods： The perioperative clinical data of 5 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively analyzed and review of the literature reported.Open radical nephrectomy plus inferior vena cava thrombectomy was conducted in 3 cases.Laparoscopic radical nephrectomy plus inferior vena cava thrombectomy was conducted in 1 case.Results： All 4 operations were successfully completed.The average operation time was 213.7 min（ 135 ~ 315） min.The average blood loss volume was 1 650.0 ml（ 600 ~ 3 500） ml.Pathological diagnosis confirmed renal clear cell carcinoma.No intraoperative or postoperative complications was observed.At a average follow-up of 12.2（ 5 ~ 30） months,there was no evidence of recurrence and distant metastasis.Conclusion： Despite the difficulty and complexity,radical surgery are recommended if feasible.Minimal invasive approach can be applied under proper condition.Presurgical assessment must be comprehensive.Multidisciplinary cooperation and close monitoring is required to prevent the abscission of tumor thrombus.Presurgical neoadjuvant targeted molecular therapy may potientially reduce the tumor thrombus classification,as well as decreasing surgical difficulty.