肾脏恶性肿瘤并静脉转移的外科治疗

Surgical treatment to renal malignant tumors with vena cava involvement

目的 :探讨肾脏恶性肿瘤并发静脉内转移的外科治疗方法及预后。方法 :报告 10例肾脏恶性肿瘤 ,其中肾细胞癌 6例 ,肾母细胞瘤 2例 ,肾盂癌 1例 ,肾平滑肌肉瘤 1例。肾静脉内转移 4例 ,肝下型腔静脉转移 5例 ,肝后和肝上的腔静脉内转移 1例。在根治性切除患肾的同时阻断瘤栓上下的腔静脉和对侧肾静脉 ,完整取除瘤栓 ,腔静脉壁受累者同时切除腔静脉壁 ,术后辅以免疫治疗和放射治疗。结果 :随访 7年 ,平均 5年生存率4 0 % ,肾母细胞瘤生存期小于 3年 ,腔静脉壁受累者生存期小于 1年 ,并发区域淋巴结转移者 5年生存率 33%。结论 :手术切除静脉内转移癌是提高患者生存期的惟一手段 ,其预后取决于原发癌肿的性质和癌栓是否完全切除 ,而与癌栓的位置无直接相关。

Purpose:To study the surgical management and the prognosis of renal maligment tumors with renal vein and vena cava matastasis. Methods:Ten cases were reported in this series: 6 patients with renal cell carcinoma, 2 with wilm's tumor, 1 with transitional cell carcinoma of renal pelvis and 1 with renal leiomyosarcoma.The tumors invaded into renal vein in 4 cases, metastasised to vena cava below the hepatic vein in 5 cases, and extended to the supradiaphragmatic vena cava in one case. After radical nephrectomy,the vena cava above and below the tumor thrombus and the opposite renal vein were occluded and the tumor thrombus were removed .The wall of the vena cava were resected when it was involved by the tumors. Immunotherapy and radiation therapy had been employed postoperatively. Results:The 5 years survival rate was 40% in this group after 7 years follow up. Patients with Wilm's tumor survived less than 3 years and the patients with tumors involveing vena cava survived less than 1 year.The 5 years survival rate of the patients with local lymph node metastasis was 33%. Conclusions:Surgical resection of the tumor metastasis to vena cava should be the most effective treatment to improve the patient survival rate .The prognosis depended on the characteristics of the primary tumor and complete resection rather than the level of tumor in the vena cava. These patients with tumor thrombus in renal vein and vena cava wall invasion or lymph node involvement would have worse prognosis.