Giannoulia-Karadana A, Moschovi M, Koutsovitis P, Tolis G, Tzortzatou-Stathopoulou F
First Department of Pediatrics, University of Athens, Agia Sophia Children's Hospital, Greece.
J Pediatr Surg. 2000 Oct;35(10):1459-61. doi: 10.1053/jpsu.2000.16414.
The neoplastic thrombus in Wilms' tumor rarely can extend in to the inferior vena cava or to the right atrium. The neoplastic thrombus usually is diagnosed concurrently with the tumor, although in some cases the diagnosis of the thrombus may precede the diagnosis of nephroblastoma.
Among 90 children with Wilms' tumor who were treated in the authors' unit, 4 had extensive tumor thrombosis of the inferior vena cava or the right atrium. One of these patients was found with a life-threatening thrombosis of the inferior vena cava and the right atrium, which was treated surgically; in this case, the diagnosis of nephroblastoma was made postoperatively. As for the 3 remaining patients the diagnosis of neoplastic thrombosis and Wilms' tumor was made simultaneously.
In the first case, the patient underwent surgical excision of the thrombus with cardiopulmonary bypass and a short period of hypothermic cardiopulmonary arrest. In the other 3 cases the thrombus resolved with chemotherapy only.
Surgical excision of extensive neoplastic thrombosis is suggested in the case of life-threatening thrombosis even with cardiopulmonary bypass. Chemotherapy is suggested in cases lacking clinical symptoms of thrombosis.
肾母细胞瘤中的肿瘤性血栓很少会延伸至下腔静脉或右心房。肿瘤性血栓通常与肿瘤同时被诊断出来，不过在某些情况下，血栓的诊断可能先于肾母细胞瘤的诊断。
在作者所在科室接受治疗的90例肾母细胞瘤患儿中，有4例出现了下腔静脉或右心房的广泛肿瘤血栓形成。其中1例患者被发现患有危及生命的下腔静脉和右心房血栓，接受了手术治疗；在该病例中，肾母细胞瘤的诊断是在术后做出的。对于其余3例患者，肿瘤性血栓和肾母细胞瘤的诊断是同时做出的。
在第一例病例中，患者在体外循环和短时间低温心肺停搏下接受了血栓的手术切除。在其他3例病例中，血栓仅通过化疗得以消退。
对于危及生命的血栓，即使需要体外循环，也建议手术切除广泛的肿瘤性血栓。对于没有血栓临床症状的病例，建议进行化疗。
