改良机器人辅助腹腔镜下右肾癌根治术联合下腔静脉Ⅰ级癌栓切除术一例报道(英文)

Modified robot-assisted laparoscopic right radical nephrectomy combined with level Ⅰ inferior vena cava tumor thrombectomy:a case report

下腔静脉癌栓切除术是泌尿系统最复杂和最具挑战性的手术之一。本文报道1例改良的机器人辅助腹腔镜下右肾癌根治术联合下腔静脉I级癌栓切除术。相比常规下腔静脉癌栓切除术,改良的机器人辅助腹腔镜下腔静脉癌栓切除术不需要完全分离下腔静脉,无需结扎腰静脉、肾上腺静脉,不用阻断下腔静脉、左肾静脉,也不需要切开下腔静脉和重建下腔静脉。本例手术先完全分离右肾,然后向侧面抬起右肾,使下腔静脉内的瘤栓降至肾静脉入下腔静脉处,然后用机械臂将瘤栓完全推进右肾静脉内,在不阻断下腔静脉的情况下完整切除瘤栓。此改良手术成功完成,无任何并发症,未进行输血。患者随访4年后无任何复发迹象。这表明此改良手术简单、安全、可行、值得推广,尤其适用于初学者。

Inferior vena cave(IVC) tumor thrombectomy is known to be one of the most challenging and intricate surgeries in the urinary system.Herein,we performed a modified robot-assisted laparoscopic right radical nephrectomy combined with level Ⅰ inferior vena cava thrombectomy in a woman with a 5cm tumor on the right kidney involving level Ⅰ IVC tumor thrombus.Comparing with the routine surgery,modified robot-assisted laparoscopic right radical nephrectomy with level Ⅰ IVC tumor thrombectomy only dissects the ventral and right lateral surfaces of IVC,with no need to circumferentially dissociate IVC and left renal vein,ligate the lumbar veins,clamp related vessels,cut the IVC wall,or reconstruct the IVC.This modified procedure was successfully fulfilled with a total surgical time of 3 hours and 45 minutes.There were no perioperative complications or blood transfusion.The modified procedure shows lower risk of hemorrhage and pulmonary embolism,which is safety and worthy of popularization.