Papadimitriou Dimitrios K, Pitoulias Georgios A, Tachtsi Maria D, Koutsias Stylianos G, Radopoulos Dimitrios K
Vascular Unit, 2nd Surgical Department, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece.
Ann Vasc Surg. 2006 Mar;20(2):223-7. doi: 10.1007/s10016-006-9001-7. Epub 2006 Mar 21.
Renal cell carcinoma produces neoplasmatic thrombus that usually invades and progressively grows into the endorenal veins. The thrombus may extend into the ipsilateral renal vein or the inferior vena cava in 15-20% and 8-15% of cases, respectively. These tumors are classified into four categories (I, II, III, and IV) according to the level of cephalad extension of thrombus into the inferior vena cava. The purpose of this study was to assess the surgical strategy for cases of renal tumor thrombus invading the vena cava. We retrospectively reviewed the records of 10 patients with renal cell carcinoma, who underwent in our institution radical nephrectomy and resection of vena cava thrombus between January 1997 and December 2004. Four patients were classified as level I, four were level II, and two were level III. In all cases, the thrombus was removed through a small cavotomy without cardiopulmonary bypass and the cavotomy was closed primarily. Pringle's maneuver was performed in the two level III cases. There were no perioperative pulmonary embolisms or deaths, and the mean hospital stay was 8 +/- 1.1 days. The mean survival was 21.8 +/- 8 months, and the vena cava remained patent for this period. Tumor thrombectomy improves the prognosis and the quality of life of these patients, and in most of cases the surgical technique, although challenging, carries a low morbidity and mortality rate.
肾细胞癌可产生肿瘤性血栓，通常侵入并逐渐生长至肾内静脉。在15% - 20%和8% - 15%的病例中，血栓可能分别延伸至同侧肾静脉或下腔静脉。根据血栓向上延伸至下腔静脉的程度，这些肿瘤分为四类（I、II、III和IV）。本研究的目的是评估肾肿瘤血栓侵犯下腔静脉病例的手术策略。我们回顾性分析了1997年1月至2004年12月期间在我院接受根治性肾切除术及下腔静脉血栓切除术的10例肾细胞癌患者的记录。4例为I级，4例为II级，2例为III级。所有病例均通过小切口开胸在非体外循环下取出血栓，并一期缝合切口。2例III级病例采用了Pringle手法。围手术期无肺栓塞或死亡病例，平均住院时间为8±1.1天。平均生存期为21.8±8个月，在此期间下腔静脉保持通畅。肿瘤血栓切除术可改善这些患者的预后和生活质量，并且在大多数情况下，尽管手术技术具有挑战性，但发病率和死亡率较低。
