“十字三步法”手术策略治疗跨肾静脉开口的下腔静脉平滑肌肉瘤的可行性

Analysis of feasibility of“cross three-step”surgical strategy in the treatment of inferior vena cava leiomyosarcoma across the orifice of renal vein

目的探讨采用“十字三步法”手术策略治疗跨肾静脉开口的下腔静脉平滑肌肉瘤(inferior vena cava leiomyosarcoma,IVCL)的可行性及安全性。方法选择2020年10月至2022年8月在海军军医大学长海医院接受“十字三步法”手术策略治疗的9例跨肾静脉开口IVCL患者。分析患者的一般资料、影像学表现、手术情况及术后并发症情况,比较患者术前、术后的肾功能指标,采用门诊或电话方式进行随访。结果9例患者均完成手术并顺利出院,其中单侧肾脏切除4例、肾静脉人工血管重建4例、下腔静脉人工血管重建1例。手术时间平均(179.4±42.9)min,手术出血量平均(1966.7±1296.1)mL。所有患者、单侧肾脏切除患者、肾静脉重建患者术前与术后2周血肌酐差异无统计学意义。结论“十字三步法”手术策略将复杂多变的下腔静脉肿瘤手术步骤标准化,具有可复制性,有助于缩短术者学习曲线,手术总体安全可靠,术后患者肾功能恢复良好。

Objective To explore the efficacy and safety of the“cross three-step”strategy in the treatment of inferior vena cava leiomyosarcoma(IVCL)across the orifice of renal vein.Methods From October 2020 to August 2022,9 patients diagnosed as IVCL across the orifice of renal vein who received“cross three-step”operation strategy in Changhai Hospital were selected.The general data,imaging findings,operation records,and postoperative complications were collected.The preoperative and postoperative renal function indexes were compared,and the patients were followed up by outpatient clinic or telephone.Results All the 9patients completed surgery and discharged from hospital,including 4 unilateral nephrectomy,4 renal vein prosthesis recontruction and 1 inferior vena cava prosthesis reconstruction.The average operative blood loss was(1966.7±1296.1)mL and the average operation time was(179.4±42.9)min.There was no significant difference in serum creatinine between preoperative and postoperative 2 weeks in all patients,and patients underwent unilateral nephrectomy or renal vein reconstruction.Conclusion The“cross three-step”surgical strategy standardizes the complicated and variable surgical procedures of inferior vena cava tumors,which is replicable and helpful to shorten the learning curve of the operators.The operation is safe and reliable,and the postoperative renal functions of these patients are well recovered.