Bader Mohammad I, Abdelaal Khaled, Rogers Timothy, Arul Suren G
Department of Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
Pediatr Surg Int. 2013 Mar;29(3):229-32. doi: 10.1007/s00383-013-3263-2. Epub 2013 Jan 24.
Wilms' tumours (WT) with retrohepatic vascular extension traditionally requires cardiac bypass for complete excision. We share our experience of these complex cases.
A retrospective review was performed of children with WT with retrohepatic vascular extension presenting to two UK children's hospitals. Tumour stage, chemotherapy, level of vascular extension, operative details and complication data were analysed.
Ten children were identified. Mean age 6.6 years (range 3.3-8.2 years); tumour side 6 right, 2 left, 2 bilateral. Level of tumour extension was to the right atrium in two, diaphragm in two, hepatic vein (HV) level in four and retrohepatic inferior vena cava (IVC) in one patient. Following chemotherapy it reduced to hepatic veins (5) or below (4). Surgery involved radical nephrectomy and complete mobilisation of the liver off the IVC, which was then clamped, opened and the thrombus excised. There were no intraoperative complications. Mean hospital stay was 9.77 days (7-20 days). Histology showed viable tumour thrombus in six patients. One patient died after 1 year from metastatic disease.
Retrohepatic extension of WT can be managed without bypass using pre-operative chemotherapy and by complete liver mobilisation. The tumour was always adherent to IVC and required sharp dissection.
传统上，伴有肝后血管延伸的肾母细胞瘤（WT）需要进行心脏搭桥手术以实现完全切除。我们分享这些复杂病例的经验。
对两家英国儿童医院收治的伴有肝后血管延伸的WT患儿进行回顾性研究。分析肿瘤分期、化疗情况、血管延伸程度、手术细节及并发症数据。
共确定10例患儿。平均年龄6.6岁（范围3.3 - 8.2岁）；肿瘤位于右侧6例，左侧2例，双侧2例。肿瘤延伸至右心房2例，膈肌2例，肝静脉（HV）水平4例，1例延伸至肝后下腔静脉（IVC）。化疗后，延伸至肝静脉（5例）或更低水平（4例）。手术包括根治性肾切除术及将肝脏从IVC完全游离，然后阻断、打开IVC并切除血栓。术中无并发症。平均住院时间为9.77天（7 - 20天）。组织学检查显示6例有存活肿瘤血栓。1例患者术后1年死于转移性疾病。
伴有肝后延伸的WT可通过术前化疗及完全游离肝脏在不进行心脏搭桥的情况下得到处理。肿瘤总是与IVC粘连，需要锐性分离。
