Metcalfe Charles, Chang-Kit Laura, Dumitru Ioana, Macdonald Shaun, Black Peter
Department of Urological Sciences, UBC, Vancouver, BC;
Can Urol Assoc J. 2010 Aug;4(4):E105-8. doi: 10.5489/cuaj.892.
Nephrectomy with inferior vena cava (IVC) thrombectomy for advanced renal cell carcinoma (RCC) is a challenging and morbid surgical case. We describe the use of a simple endoluminal technique to occlude the suprahepatic IVC during thrombectomy. A 60-year-old male presented with a large right-sided RCC and IVC tumour thrombus. The tip of the thrombus, which was non-adherent to the caval wall, extended to the level of the hepatic veins. After complete dissection of the kidney, we obtained suprahepatic control of the IVC by a large compliant balloon, introduced through the right internal jugular vein and inflated just below the level of the diaphragm. The IVC thrombectomy was performed in a bloodless field. Mean blood pressure remained stable during IVC balloon inflation with a total occlusion time of 10 minutes. Intraprocedural completion cavogram and postoperative Doppler ultrasonography showed no residual IVC clot. Blood loss during the thrombectomy portion of the case was scant. The patient's postoperative course was uncomplicated and, at the last follow-up, he had stable metastatic disease on sunitinib therapy. For the surgical treatment of RCC with retrohepatic IVC tumour extension, transjugular balloon occlusion of the suprahepatic IVC offers an alternative to extensive hepatic mobilization to obtain suprahepatic thrombus control. Advantages over traditional surgical methods may include decreased surgical time, lower risk of liver injury and tumour embolism. We suggest this method for further evaluation.
对于晚期肾细胞癌（RCC）行肾切除术并下腔静脉（IVC）血栓切除术是一个具有挑战性且创伤性大的外科病例。我们描述了一种在血栓切除术中使用简单腔内技术闭塞肝上腔静脉的方法。一名60岁男性，患有右侧巨大肾细胞癌及下腔静脉肿瘤血栓。血栓尖端未粘连于腔静脉壁，延伸至肝静脉水平。在完整切除肾脏后，我们通过一个大型顺应性球囊获得了肝上腔静脉的控制，该球囊经右颈内静脉置入并在膈下水平充气。在无血视野下进行下腔静脉血栓切除术。在腔静脉球囊充气期间平均血压保持稳定，总闭塞时间为10分钟。术中完成的腔静脉造影及术后多普勒超声检查显示下腔静脉无残留血栓。该病例血栓切除部分的失血量很少。患者术后病程顺利，在最后一次随访时，接受舒尼替尼治疗的转移性疾病病情稳定。对于伴有肝后下腔静脉肿瘤延伸的肾细胞癌的外科治疗，经颈静脉球囊闭塞肝上腔静脉为获得肝上血栓控制提供了一种替代广泛肝脏游离的方法。与传统手术方法相比，其优势可能包括手术时间缩短、肝损伤和肿瘤栓塞风险降低。我们建议对该方法进行进一步评估。
