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手术切除及下腔静脉重建治疗恶性肿瘤:技术成功与疗效

Surgical resection and inferior vena cava reconstruction for treatment of the malignant tumor: technical success and outcomes.

作者信息

Goto Hitoshi, Hashimoto Munetaka, Akamatsu Daijiro, Shimizu Takuya, Miyama Noriyuki, Tsuchida Ken, Tajima Yuta, Ohuchi Noriaki

机构信息

Division of Advanced Surgical Science and Technology, Tohoku University Hospital, Sendai, Miyagi, Japan.

出版信息

Ann Vasc Dis. 2014;7(2):120-6. doi: 10.3400/avd.oa.13-00125. Epub 2014 Mar 15.

Abstract

OBJECTIVE

The purpose of this study was to review patients who underwent inferior vena cava (IVC) resection with concomitant malignant tumor resection and to consider the operative procedures and the outcomes.

MATERIALS AND METHODS

Between 2000 and 2012, 41 patients underwent resection of malignant tumors concomitant with surgical resection of the IVC at our institute. The records of these patients were retrospectively reviewed.

RESULTS

Primary tumor resections included nephrectomy, hepatectomy, retroperitoneal tumor extirpation, lymph node dissection, and pancreaticoduodenectomy. The IVC interventions were partial resection in 23 patients and total resection in 18 patients. Four patients underwent IVC replacement. Operation-related complications included pulmonary embolism, acute myocardial infarction, deep vein thrombosis, leg edema and temporary hemodialysis. There were no operative deaths. The mean follow-up period was 24.9 months (range: 2-98 months). The prognosis depended on the type and stage of the tumor.

CONCLUSION

Resection and reconstruction of the IVC can be performed safely if the preoperative evaluations and surgical procedures are performed properly. The IVC resection without reconstruction was permissive if the IVC was completely obstructed preoperatively, but it may also be considered in cases where the IVC is not completely obstructed.

摘要

目的

本研究旨在回顾接受下腔静脉(IVC)切除并同时进行恶性肿瘤切除的患者,并探讨手术方法及治疗效果。

材料与方法

2000年至2012年间,我院41例患者接受了IVC切除并同时进行恶性肿瘤切除手术。对这些患者的病历进行回顾性分析。

结果

原发肿瘤切除包括肾切除术、肝切除术、腹膜后肿瘤切除术、淋巴结清扫术和胰十二指肠切除术。IVC手术中,23例患者行部分切除术,18例患者行全切除术。4例患者接受了IVC置换术。手术相关并发症包括肺栓塞、急性心肌梗死、深静脉血栓形成、腿部水肿和临时血液透析。无手术死亡病例。平均随访时间为24.9个月(范围:2 - 98个月)。预后取决于肿瘤的类型和分期。

结论

如果术前评估和手术操作得当,IVC切除及重建手术可安全进行。如果术前IVC完全阻塞,可不进行重建直接切除IVC,但在IVC未完全阻塞的情况下也可考虑切除。

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