Fergany Amr F, Gill Inderbir S, Schweizer Dana K, Kaouk Jihad H, ElFettouh Hazem Abou, Cherullo Edward E, Meraney Anoop M, Sung Gyung Tak
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Ohio 44195, USA.
J Urol. 2002 Dec;168(6):2629-31. doi: 10.1016/S0022-5347(05)64232-2.
Inferior vena caval tumor thrombus due to renal cell carcinoma generally precludes laparoscopic techniques for radical nephrectomy. We developed the technique of laparoscopic infrahepatic (level II) inferior vena caval thrombectomy in a survival porcine model.
Of the 7 female pigs used in the study 2 were acute and 5 were chronic animals which were allowed to survive for 6 weeks postoperatively. Laparoscopic right radical nephrectomy and inferior vena caval thrombectomy were performed in accordance with established open surgical principles, including vascular control and intracorporeal reconstruction of the vena cava and left renal vein.
Complete removal of the simulated caval thrombus was successful in each case without intraoperative or postoperative complications. Average operative time was 160 minutes. Postoperatively inferior venacavography showed a patent vena cava and left renal vein in all animals.
Laparoscopic radical nephrectomy was successful in an animal model simulating renal cell carcinoma with infrahepatic vena caval tumor thrombus. Clinical application of this technique appears possible.
肾细胞癌导致的下腔静脉肿瘤血栓通常使腹腔镜根治性肾切除术技术无法实施。我们在存活的猪模型中开发了腹腔镜肝下（II级）下腔静脉血栓切除术技术。
研究中使用的7只雌性猪，2只为急性动物，5只为慢性动物，术后存活6周。按照既定的开放手术原则进行腹腔镜右根治性肾切除术和下腔静脉血栓切除术，包括血管控制以及腔静脉和左肾静脉的体内重建。
每例均成功完全清除模拟的腔静脉血栓，无术中或术后并发症。平均手术时间为160分钟。术后下腔静脉造影显示所有动物的腔静脉和左肾静脉通畅。
在模拟伴有肝下腔静脉肿瘤血栓的肾细胞癌的动物模型中，腹腔镜根治性肾切除术成功。该技术的临床应用似乎可行。
