Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2009 Sep 20;122(18):2155-8.
An important characteristic of renal cell carcinomas and adrenal tumors is that these tumors may expand into the renal vein and inferior vena cava, and transform into tumor thrombi. This study was to evaluate the use of piggyback liver transplant techniques for surgical management of urological tumors with inferior vena cava tumor thrombus.
Nineteen patients with renal cell carcinomas or adrenal tumors with inferior vena cava tumor thrombus were treated from November 1995 to April 2008. Their ages ranged from 29 years to 76 years (mean 54 years). The extent of tumor thrombus was infrahepatic (level I) in 2, retrohepatic (level II) in 7, suprahepatic (level III) in 6, and intra-atrial (level IV) in 4 patients. We used cardiopulmonary bypass with deep hypothermic circulatory arrest to remove the thrombi in 3 cases of level IV and in 2 cases of level III. In all level II, 4 level III, and 2 level IV cases, we used piggyback liver transplant techniques to mobilize the liver off of the inferior vena cava and to separate the inferior vena cava from the posterior abdominal wall.
Mean operative time was 5.1 hours, mean estimated blood loss was 2289 ml and mean blood transfusion was 12.84 U. One patient with adrenal cortical carcinoma and level IV thrombus died in the immediate postoperative period. Three patients were lost to follow up, and the other 15 survivors were followed from 5 months to 56 months. Eight of these 15 patients died due to metastasis; however 7 were still alive at the last follow-up.
An aggressive surgical approach is the only hope for curing patients diagnosed with urological tumors combined with inferior vena cava tumor thrombus. The use of piggyback liver transplant techniques to mobilize the liver off of the inferior vena cava provides excellent exposure of the inferior vena cava. Patients with a level II or level III inferior vena cava thrombus may be treated without using cardiopulmonary bypass.
肾细胞癌和肾上腺肿瘤的一个重要特征是这些肿瘤可能会扩展到肾静脉和下腔静脉，并转化为肿瘤血栓。本研究旨在评估使用劈裂式肝移植技术治疗下腔静脉肿瘤合并肿瘤血栓的泌尿外科肿瘤。
1995 年 11 月至 2008 年 4 月，我们治疗了 19 例肾细胞癌或肾上腺肿瘤合并下腔静脉肿瘤血栓患者。患者年龄 29 岁至 76 岁，平均 54 岁。2 例肿瘤血栓位于肝下（I 级），7 例位于肝后（II 级），6 例位于肝上（III 级），4 例位于心房内（IV 级）。我们使用心肺转流和深低温循环停搏来清除 3 例 IV 级和 2 例 III 级患者的血栓。在所有 II 级、4 例 III 级和 2 例 IV 级患者中，我们采用劈裂式肝移植技术将肝脏从下腔静脉上移开，并将下腔静脉与后腹壁分离。
平均手术时间为 5.1 小时，估计失血量为 2289ml，平均输血 12.84U。1 例肾上腺皮质癌合并 IV 级血栓患者术后即刻死亡。3 例患者失访，其余 15 例幸存者随访 5 个月至 56 个月。这 15 例患者中有 8 例因转移而死亡，但最后一次随访时仍有 7 例存活。
积极的手术方法是治愈诊断为泌尿系统肿瘤合并下腔静脉肿瘤血栓患者的唯一希望。采用劈裂式肝移植技术将肝脏从下腔静脉上移开，可以提供下腔静脉的良好暴露。对于 II 级或 III 级下腔静脉血栓患者，可以不使用心肺转流。
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