Kanda T, Miyamoto H, Hayakawa K, Hata E
Department of Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Oct;39(10):1966-70.
A case was reported concerning a successful removal of tumor thrombus extending into the right atrium through the left brachiocephalic vein and the superior vena cava. The patient was a 34-year-old man who underwent a left inguinal orchiectomy for immature teratoma of testis in June 1987. The operation was followed by another three operations for excision of lymph node metastases and five courses of cisplatin based combination chemotherapy. In December 1988, the chest CT scan film revealed filling defect in the superior vena cava and the right atrium. Thrombus was detected using echocardiography and angiography. He had no symptom, but multiple pulmonary infarcts were also detected. In February 1989, the operation was performed by means of cardio-pulmonary bypass. A soft yellowish thrombus attached to the left venous angle was removed with resection of the left brachiocephalic vein. Microscopic findings revealed that the thrombus was metastatic testicular teratoma. With further treatment after the operation, he has been disease-free for 14 months now. We conclude that in this case aggressive surgical management following chemotherapy had great value to control the disseminated testicular tumor.
报告了一例成功切除经左头臂静脉和上腔静脉延伸至右心房的肿瘤血栓的病例。患者为一名34岁男性，1987年6月因睾丸未成熟畸胎瘤接受了左腹股沟睾丸切除术。术后又进行了三次淋巴结转移切除术和五个疗程的以顺铂为基础的联合化疗。1988年12月，胸部CT扫描显示上腔静脉和右心房有充盈缺损。通过超声心动图和血管造影检测到血栓。他没有症状，但也检测到多处肺梗死。1989年2月，通过体外循环进行手术。切除左头臂静脉，清除附着于左静脉角的柔软淡黄色血栓。显微镜检查发现血栓为转移性睾丸畸胎瘤。术后经过进一步治疗，他至今已无病生存14个月。我们得出结论，在该病例中，化疗后积极的手术治疗对于控制播散性睾丸肿瘤具有重要价值。
