Araujo Raphael L C, Gaujoux Sébastien, D'Albuquerque Luiz Augusto Carneiro, Sauvanet Alain, Belghiti Jacques, Andraus Wellington
Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil.
Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, Beaujon Hospital, Clichy, France; University Paris 7 Denis Diderot, Paris, France.
Ann Vasc Surg. 2014 May;28(4):1048-51. doi: 10.1016/j.avsg.2013.08.027. Epub 2013 Dec 13.
When retrohepatic inferior vena cava (IVC) resection is required, for example, for IVC leiomyosarcoma, reconstruction is recommended. This is particularly true when the renal vein confluence is resected to preserve venous outflow, including that of the right kidney.
Two patients with retrohepatic IVC leiomyosarcoma involving renal vein confluences underwent hepatectomy with en bloc IVC resection below the renal vein confluence. IVC reconstruction was not performed, but end-to-end renal vein anastomoses were, including a prosthetic graft in 1 case.
The postoperative course was uneventful with respect to kidney function, anastomosis patency assessed using Doppler ultrasonography and computerized tomography, and transient lower limb edema.
End-to-end renal vein anastomosis after a retrohepatic IVC resection including the renal vein confluence should be considered as an alternative option for preserving right kidney drainage through the left renal vein when IVC reconstruction is not possible or should be avoided.
当需要进行肝后下腔静脉（IVC）切除时，例如对于IVC平滑肌肉瘤，建议进行重建。当肾静脉汇合处被切除以保留静脉流出道，包括右肾的静脉流出道时，情况尤其如此。
两名患有累及肾静脉汇合处的肝后IVC平滑肌肉瘤的患者接受了肝切除术，并在肾静脉汇合处下方整块切除IVC。未进行IVC重建，但进行了肾静脉端端吻合，其中1例使用了人工血管。
术后肾功能、使用多普勒超声和计算机断层扫描评估的吻合口通畅情况以及短暂性下肢水肿方面的病程均平稳。
当无法进行或应避免进行IVC重建时，在包括肾静脉汇合处的肝后IVC切除术后进行肾静脉端端吻合应被视为通过左肾静脉保留右肾引流的一种替代选择。
