Nishiyama H, Nakamura K, Nishimura M, Nishimura K, Takahashi Y, Fujii K
Department of Urology, Osaka Red Cross Hospital.
Hinyokika Kiyo. 1991 Sep;37(9):1029-34.
Renal cell carcinoma with extended tumor thrombi densely adherent to the vena caval wall sometimes requires vena caval resection. If the tumor is on the right side and the collateral veins of the left renal vein are abundant, vena caval reconstruction may not be required. We recently performed radical nephrectomy and vena caval resection on 2 right renal cell carcinoma patients. To decide the necessity of vena caval reconstruction, left renal vein pressure was measured before and after clamping of the vena cava. In case 1, because the pressure was elevated from 21 cmH2O, to 61 cmH2O, total replacement with Gore-Tex graft was performed. In case 2, because the pressure change was from 22 cmH2O to 23 cmH2O, reconstruction was not performed. The most important test to decide the necessity of vena caval reconstruction is thought to be the change of renal venous pressure before and after clamping of the vena cava.
肿瘤血栓广泛粘连于腔静脉壁的肾细胞癌有时需要进行腔静脉切除术。如果肿瘤位于右侧且左肾静脉的侧支静脉丰富，则可能不需要进行腔静脉重建。我们最近对2例右肾细胞癌患者进行了根治性肾切除术和腔静脉切除术。为了确定腔静脉重建的必要性，在腔静脉阻断前后测量了左肾静脉压力。病例1中，由于压力从21 cmH₂O升高至61 cmH₂O，因此采用Gore-Tex人工血管进行了全置换。病例2中，由于压力变化从22 cmH₂O至23 cmH₂O，因此未进行重建。决定腔静脉重建必要性的最重要检查被认为是腔静脉阻断前后肾静脉压力的变化。
