Bonamigo Telmo Pedro, Becker Monica, Faccini Felipe Puricelli, Cantisani Guido Pio Gracco, Pereira Wagner Michael, de Napoli Gilberto, de Oliveira Ilha Darcy
Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Vascular Surgery Department, Porto Alegre, RS, Brazil.
Vasc Endovascular Surg. 2003 May-Jun;37(3):225-8. doi: 10.1177/153857440303700311.
This paper presents a patient successfully treated for leiomyosarcoma of the vena cava, with no recurrence or symptoms on an 8-year follow-up. A 56-year-old woman presented with chronic and progressive periumbilical and right upper abdominal pain. Physical examination and laboratory tests revealed no abnormalities. Computed tomography showed a high-density image inside the vena cava. Cavography showed a filling defect with complete occlusion of the vena cava involving the renal veins and greatly developed collateral circulation through lumbar veins. Laparotomy was performed and a large caval mass involving the renal veins was dissected and resected. Venous reconstruction was undertaken using a 19-mm bovine pericardium prosthesis (Labcor, MG-Brazil) interposed as a substitute to the vena cava, and the renal veins were anastomosed to the side of the graft. Pathologic examination confirmed a leiomyosarcoma with free surgical margins. The postoperative course was uneventful and the patient was discharged on postoperative day 8. The venous flow through the inferior vena became normal, as confirmed by later cavography. This paper presents a case of successfully managed leiomyosarcoma of the vena cava with a thorough review of the literature. The treatment of such patients and the use of bovine pericardium are also discussed.
本文介绍了一名腔静脉平滑肌肉瘤患者，经治疗后成功康复，在8年的随访中无复发且无任何症状。一名56岁女性出现慢性进行性脐周及右上腹疼痛。体格检查和实验室检查均未发现异常。计算机断层扫描显示腔静脉内有高密度影像。腔静脉造影显示有充盈缺损，腔静脉完全闭塞，累及肾静脉，通过腰静脉形成大量侧支循环。行剖腹手术，切除了累及肾静脉的巨大腔静脉肿块。使用19毫米的牛心包补片（Labcor，巴西MG公司）作为腔静脉的替代物进行静脉重建，肾静脉与移植物侧吻合。病理检查证实为平滑肌肉瘤，手术切缘无肿瘤残留。术后过程顺利，患者于术后第8天出院。后来的腔静脉造影证实，下腔静脉血流恢复正常。本文介绍了一例成功治疗的腔静脉平滑肌肉瘤病例，并对相关文献进行了全面回顾。同时还讨论了此类患者的治疗方法及牛心包的应用。
