Brown Robert J, Uhlman Matthew A, Fernandez Joss D, Collins Thomas, Brown James A
Department of Urology, University of Iowa, Iowa City, Iowa, USA.
Department of Cardiothoracic Surgery, University of Iowa, Iowa City, Iowa, USA.
Curr Urol. 2013 Aug;7(1):34-6. doi: 10.1159/000343550. Epub 2013 Jul 28.
Venous tumor thrombus occurs in 5-10% of patients with renal cell carcinoma. Surgical excision offers the best chance for survival, but is technically difficult. Risk of pulmonary embolism from venous thrombus or tumor thrombus is high, especially with tumors located higher in the inferior vena cava. Cardiopulmonary bypass may be used when a tumor extends above the diaphragm, but carries significant risk. We present an 86-year-old woman with a 7 cm renal mass extending into the inferior vena cava just below the confluence of the hepatic vessels. Prior to surgery she was found to have increasing pulmonary embolisms despite appropriate anticoagulation. Intraoperatively, the AngioVac aspiration system was utilized to prevent further pulmonary embolism. This is the first reported case of the use of this system during radical nephrectomy.
静脉肿瘤血栓见于5%至10%的肾细胞癌患者。手术切除提供了最佳的生存机会，但技术上难度较大。静脉血栓或肿瘤血栓导致肺栓塞的风险很高，尤其是肿瘤位于下腔静脉较高位置时。当肿瘤延伸至膈肌上方时可使用体外循环，但风险很大。我们报告一例86岁女性，其7厘米的肾肿物延伸至肝血管汇合处下方的下腔静脉。术前发现尽管进行了适当的抗凝治疗，但她的肺栓塞仍在增加。术中使用了AngioVac抽吸系统以预防进一步的肺栓塞。这是首例在根治性肾切除术中使用该系统的报道病例。
