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机器人手术治疗肾原始神经外胚叶肿瘤伴下腔静脉癌栓一例报告

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摘要 患者,男,20岁。2018年1月19日因反复左侧腰痛伴肉眼血尿3周,加重3 d入院。既往体健,查体:左肾区可触及包块,压痛(+),质硬,不可推动,余专科查体阴性。肿瘤标志物检查均正常。B超检查:左肾16.0 cm×8.2 cm大小低回声团,呈椭圆形,球体感,包块内见丰富血流信号,呈抱球征;左肾静脉内可见低回声充填。CT检查:左肾占位性病变,大小约16 cm×12 cm,考虑恶性病变;肾静脉、下腔静脉局部癌栓形成(图1)。根据CT初步评估下腔静脉癌栓顶端距肾静脉开口处约3 cm,Mayo分级为Ⅱ级。术前诊断为左肾恶性肿瘤并下腔静脉癌栓形成。术前1 d行左肾动脉栓塞术。全麻下行机器人辅助腹腔镜根治性肾切除术+下腔静脉癌栓取出术+淋巴结清扫术,患者体位及套管位置参考文献[2]。切开肝结肠韧带,向内侧推开结肠及十二指肠,助手经剑突下辅助孔推开肝脏,充分暴露及游离下腔静脉,沿下腔静脉游离左右肾静脉及右肾动脉,游离过程中用Hem-o-lok夹闭周围小血管,用切割闭合器离断左肾静脉,然后用束带分别阻断下腔静脉癌栓上下缘,用动脉血管钳夹闭右肾动静脉。切开下腔静脉,完整取出癌栓置入标本袋中,肝素钠水冲洗下腔静脉并缝合,松开束带及动脉血管钳,未见出血;清扫腹主动脉旁淋巴结。
出处 《中华泌尿外科杂志》 CAS CSCD 北大核心 2019年第12期942-943,共2页 Chinese Journal of Urology
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