肾癌并肾静脉、下腔静脉、右心房癌栓的外科治疗(附3例报告)

Surgical Treatment of Renal Tumor with Tumor Thrombus in Inferior Vena Cava and Right Atrium:a Report of Three Cases with Long-Term Follow-up

目的评价肾肿瘤并肾静脉、下腔静脉、右心房癌栓患者行根治性肾切除术及取栓术后的早期和远期疗效。方法对本院2011年3月至2013年5月手术治疗的3例肾肿瘤并肾静脉、下腔静脉、右心房癌栓的患者进行回顾性分析。本单位泌尿外科团队联合心外科团队对这3例患者施行了根治性肾切除术及低温体外循环下右心房和腔静脉癌栓取栓术,手术过程顺利。术后规律随访,第1年患者每3个月复查评估1次,第2年及第3年每6个月1次,此后1年1次。结果所有患者术中无栓塞,无院内死亡。1例患者术后6个月发生肺转移,2年后死亡。另外2例患者健在(分别随访90个月、64个月),在未给予其他的辅助治疗情况下没有发现肿瘤复发或转移。结论肾肿瘤并肾静脉、下腔静脉、右心房癌栓患者手术治疗需要多学科参与。根治性肾切除术及低温体外循环下能安全有效地进行右心房和腔静脉癌栓取栓术,并发症发生率低。准确的诊断及合理的治疗措施能减少相关的并发率和死亡率。长期随访结果是可喜的。但需要更多更大样本量的研究结果来进一步验证。

Objective To evaluate early and long-term results of radical surgical removal of renal cell cancer( RCC) with tumor thrombus( TT) in the inferior vena cava( IVC) and right atrium( RA). Methods The study included three patients with RCC with TT in IVC and right atrium,who underwent surgical treatments from March 2011 to May 2013 in our hospital. All patients underwent atrial and caval thrombectomy using the hypothermic cardiopulmonary bypass( CPB) and the radical nephrectomy,by a joint cardiovascular and urological team. After the surgery,patients were evaluated every 3 months for the first year,every 6 months for the next 2 years,and yearly thereafter. Results There were no peri-operative embolism and no in-hospital deaths. One patient developed tumor metastasis in lung during 6 months and died within 2 year after the surgery. The other two patients are remaining alive( following-up 90 and 64 months,respectively) with no evidence of tumor recurrence or metastases. No patients received adjuvant therapy. Conclusions Patients with RCC and the extension of TT in IVC and right atrium need a multidisciplinary surgical strategy. Radical nephrectomy,Atrial and caval tumor thrombectomy can be performed safely and effectively,with a low complication rate,using CPB. Immediate diagnosis and awareness of clinical management in such circumstances contribute to a decrease in the associated morbidity and mortality. The long-term results are promising. However,the prospective multicentre studies with larger samles are necessary.