Cosciani Cunico S, Cozzoli A, Frego E, Zambolin T, Cancarini G, Tralce L
Divisione Clinicizzata di Urologia dagli Spedali Civili di Brescia.
Arch Ital Urol Nefrol Androl. 1991 Jun;63(2):233-8.
The incidence of renal cell carcinoma with a vena caval tumour thrombus has been reported in the literature, form 4% to 19%. Vena caval involvement causes serious diagnostic and therapeutic problems. Surgical treatment is usually conditioned by the tumor thrombus cranial extension and the possible invasion of the vena caval wall. Using Diagnostic Imaging (ECHO, CAT, MRI) we are able to establish the real presence, dimension and extension of the tumor thrombus, but we can not evaluate precisely its nature or the infiltration of the vena caval wall. We report our own experience in 27 patients with renal cell carcinoma extending into the vena cava (22 cases with tumor thrombus extending under the diaphragm and 5 cases over the diaphragm) and describe our favourite approach for thrombus extending into the right atrium using extracorporeal circulation, profound hypothermia and cardiac arrest (3 cases). From our data, we believe that the vena cava involvement doesn't make the prognosis any worse, if it isn't associated with the infiltration of the vena caval wall and nodal disease.
文献报道肾细胞癌合并腔静脉瘤栓的发生率为4%至19%。腔静脉受累会引发严重的诊断和治疗问题。手术治疗通常取决于肿瘤栓子的头端延伸情况以及腔静脉壁是否可能受到侵犯。利用诊断性影像学检查（超声心动图、计算机断层扫描、磁共振成像），我们能够确定肿瘤栓子的实际存在、大小和延伸范围，但无法精确评估其性质或腔静脉壁的浸润情况。我们报告了27例肾细胞癌侵犯下腔静脉患者的自身经验（22例肿瘤栓子延伸至膈肌以下，5例延伸至膈肌以上），并描述了我们采用体外循环、深度低温和心脏停搏处理延伸至右心房的栓子的首选方法（3例）。根据我们的数据，我们认为，如果腔静脉受累不伴有腔静脉壁浸润和淋巴结病变，预后不会更差。
