1 Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China .
J Endourol. 2014 Jul;28(7):819-24. doi: 10.1089/end.2014.0066. Epub 2014 Apr 22.
To describe our pure retroperitoneal laparoscopic radical nephrectomy (LRN) with thrombectomy for right renal masses with renal vein (RV) and inferior vena cava (IVC) thrombus.
Five patients with right renal masses with RV and IVC thrombus underwent pure retroperitoneal LRN. Three patients had a history of abdominal surgery. In one patient with a RV thrombus, the RV was ligated and dissected with Hem-o-lok clips; in four patients with IVC thrombus, the IVC was partially occluded with a laparoscopic vascular clamp and incised distal to its junction with the right RV, and the thrombus was delivered intact. The IVC was closed with a running 3-0 polypropylene suture.
Pure retroperitoneal LRN with thrombectomy was successfully performed for all the patients without hand-assisted or open conversion. The mean tumor size was 6.2 cm, and mean thrombus length was 2.8 cm; four thrombi extended 0.6-1.0 cm into the IVC, and the mean operative time was 127 minutes with the average estimated blood loss at 148 mL. The mean hospital stay was 5 days. Histology revealed two renal-cell carcinomas, one angiomyolipoma, one renal pelvic transitional-cell carcinoma, and one renal infarction. All the surgical margins were negative. With a mean follow-up of 35 months, metastatic diseases did not develop in any patient.
Despite the technical challenges, pure retroperitoneal LRN for right renal masses with a RV and IVC thrombus is safe and feasible in appropriately selected patients using a retroperitoneal approach. In patients with minimal caval involvement, our surgical approach provided an alternative treatment option, especially when the patients had a history of abdominal surgery.
描述我们为右肾肿块伴肾静脉（RV）和下腔静脉（IVC）血栓患者实施的单纯后腹腔镜根治性肾切除术（LRN）并取栓。
5 例右肾肿块伴 RV 和 IVC 血栓患者接受了单纯后腹腔镜 LRN。3 例有腹部手术史。1 例 RV 血栓患者，RV 结扎并用 Hem-o-lok 夹解剖；4 例 IVC 血栓患者，IVC 用腹腔镜血管夹部分阻断，在其与右 RV 交界处下方切开，完整取出血栓。IVC 用连续 3-0 聚丙烯缝线关闭。
所有患者均成功完成了单纯后腹腔镜取栓 LRN，无手助或中转开放。肿瘤平均大小为 6.2cm，血栓平均长度为 2.8cm；4 例血栓延伸至 IVC 内 0.6-1.0cm，手术时间平均为 127 分钟，平均估计出血量为 148mL。平均住院时间为 5 天。组织学显示 2 例肾细胞癌、1 例血管平滑肌脂肪瘤、1 例肾盂移行细胞癌和 1 例肾梗死。所有手术切缘均为阴性。平均随访 35 个月，无患者发生转移疾病。
尽管存在技术挑战，但对于适当选择的患者，采用后腹腔镜入路，单纯后腹腔镜治疗右肾肿块伴 RV 和 IVC 血栓是安全可行的。对于下腔静脉受累最小的患者，我们的手术方法提供了一种替代治疗选择，特别是当患者有腹部手术史时。
