Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Eur Urol. 2015 Jul;68(1):115-22. doi: 10.1016/j.eururo.2014.12.011. Epub 2014 Dec 19.
Radical nephrectomy with inferior vena cava (IVC) thrombectomy is the preferred treatment for renal cell carcinoma (RCC) with IVC thrombus. However, IVC thrombectomy using a laparoscopic approach has not been reported for high-level thrombi.
To describe the surgical technique for laparoscopic IVC thrombectomy in patients with different thrombus levels and to assess its safety and feasibility.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of medical records for 11 patients with right-side RCC, including six patients with level II IVC thrombus and five patients with level IV thrombus.
Laparoscopic thrombectomy for level II thrombus was performed after clamping the infrarenal IVC, left renal vein, and infrahepatic IVC. Laparoscopic thrombectomy and thoracoscope-assisted open atriotomy for level IV thrombus were performed after establishing cardiopulmonary bypass and clamping the infrarenal IVC, left renal vein, and hepatoduodenal ligament.
The intraoperative variables, postoperative complications, and surgical outcomes were assessed.
The median operative time was 210min. The median IVC clamping time for patients with level II and level IV thrombus was 16.5 and 31min, respectively. The median estimated blood loss was 510ml, and no major intraoperative or postoperative complications occurred. One patient with level IV thrombus died of brain metastasis 6 mo after the operation, and the remaining ten patients had no local recurrence or distant metastasis during a median follow-up period of 31 mo.
Laparoscopic IVC thrombectomy for level II thrombus and well-selected level IV thrombus may be a safe and technically feasible alternative to open surgery.
We studied the treatment of patients with an inferior vena cava thrombus at different levels using a laparoscopic approach. This technique was safe and feasible in well-selected patients.
对于合并静脉癌栓的肾癌，根治性肾切除术联合下腔静脉（IVC）取栓术是首选的治疗方法。然而，对于高位血栓，尚未有腹腔镜下取栓的报道。
探讨腹腔镜下不同层面 IVC 取栓术的手术技巧，并评估其安全性和可行性。
设计、地点和患者：回顾性分析 11 例行腹腔镜下右肾癌根治术合并 IVC 取栓术患者的临床资料，其中 6 例为 II 级 IVC 血栓，5 例为 IV 级血栓。
对于 II 级血栓，在夹闭肾下段 IVC、左肾静脉及肝下段 IVC 后，行腹腔镜下取栓术。对于 IV 级血栓，先建立体外循环，夹闭肾下段 IVC、左肾静脉及肝十二指肠韧带，然后行腹腔镜下取栓联合胸腔镜辅助经胸骨正中劈开取栓术。
记录术中相关变量、术后并发症及手术结果。
手术时间中位数为 210min。II 级和 IV 级血栓患者的 IVC 阻断时间中位数分别为 16.5min 和 31min。估计失血量中位数为 510ml，无术中及术后严重并发症发生。1 例 IV 级血栓患者术后 6 个月死于脑转移，10 例患者在中位随访 31 个月期间无局部复发或远处转移。
对于 II 级 IVC 血栓和选择合适的 IV 级血栓，腹腔镜 IVC 取栓术可能是一种安全且可行的替代开放手术的方法。
我们研究了不同层面 IVC 血栓患者采用腹腔镜手术的治疗方法。该技术在选择合适的患者时是安全且可行的。
