肿瘤累及肾上段下腔静脉的手术治疗经验

Surgical experience of tumor involving the superior renal inferior vena cava

目的探讨肿瘤累及肾上段下腔静脉的手术路径、阻断方法、重建方法。方法收集2007年1月至2017年8月济宁医学院附属医院收治的19例肿瘤累及肾上段下腔静脉患者,所有患者依据术前及术中肿瘤情况采取相应的手术方法,2例下腔静脉平滑肌肉瘤患者行肿瘤根治性切除术+静脉瘤栓取出术,17例肾癌合并下腔静脉癌栓的患者中14例单纯行剥离和切开取栓缝合,1例采用补片成形,1例行下腔静脉切除人工血管重建,1例下腔静脉结扎。结果19例患者均顺利施行肿瘤根治性肿瘤切除术及瘤栓取出,术后恢复较好,无围手术期死亡,无肝功能衰竭、肺栓塞、肾功能衰竭等严重并发症,随访均获得良好的无瘤生存期。结论当肿瘤累及下腔静脉时,根据肿瘤的类型和范围、累及下腔静脉节段、腔静脉梗阻程度、静脉侧支代偿情况,采用不同的手术入路和方法显露、阻断、重建下腔静脉,可安全有效地达到肿瘤的根治性切除。

Objective To investigate the surgical approach,blocking,and reconstruction methods for tumors involving the superior renal inferior vena cava.Method A total of 19 patients with tumor thrombus involving the superior renal segment and inferior vena cava admitted to Affiliated Hospital of Jining Medical University from January 2007 to August 2017 were collected.All patients underwent corresponding surgical methods before and during the operation according to the type of tumor involvement.Among them,2 patients with inferior vena cava leiomyosarcoma underwent radical tumor resection+venous tumor thrombus removal,17 patients with renal cell carcinoma complicated with tumor thrombus in the inferior vena cava.In the 17 patients,14 patients underwent simple dissection,incision,and thrombectomy;1 patient underwent patch forming;1 patient underwent inferior vena cava resection and artificial blood vessel reconstruction;1 patient underwent inferior vena cava ligation.Result All the 19 patients successfully underwent radical tumor resection and tumor thrombus removal.The postoperative recovery was good,without perioperative death,liver failure,pulmonary embolism,renal failure and other serious complications.Good tumor free survival was achieved during follow-up.Conclusion When the tumor invades the inferior vena cava,it is necessary to adopt different surgical approaches and methods to expose,block and reconstruct the inferior vena cava according to the type and location of the tumor,the segment of the inferior vena cava involved,the degree of vena cava obstruction,and the compensation of venous collaterals.Taking the above decisions can safely and effectively achieve the purpose of radical tumor resection.