[节段性腔静脉切除术治疗侵犯肿瘤血栓的肾肿瘤]

Ye J F, Ma L L, Zhao L, Wang G L

Department of Urology, Peking University Third Hospital, Beijing100191, China.

Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Feb 18;50(1):183-187.

OBJECTIVE

To investigate the safety and perioperative experience of the segmental resection of the vena cava.

METHODS

From May 2015 to July 2017, 92 renal tumor patients with venous tumor thrombus were treated in Peking University Third Hospital, of whom 17 underwent nephrectomy with resection of the invaded vena cava for renal tumor with tumor thrombus invading vena cava. The preoperative features included that 15 patients were male and 2 female, the mean age was (59.2±12.9) years (31-84 years), 6 cases were left sided and 11 right sided, and the mean diameter of the renal tumor was (9.1±3.7) cm (3-14.5 cm).

RESULTS

In this group of 17 cases, 5 patients underwent resection of the vena cava via laparoscopy (including 2 open conversions), and 12 via open procedures (including 2 cardiopulmonary bypasses). The mean operation time was (430.4±120.7) min (284-694 min) and the mean intraoperative blood loss was (2 918.8±2 608.2) mL (300-10 000 mL). The vena cava from the bottom to the top was transected. The median length of the tumor thrombus in the vena cava was 10 cm (3-21 cm). Postoperative complications were found in 11 patients, including grade I in 1 case, grade II in 7 cases, grade IV in 2 cases and grade V in 1 case according to the Clavien system. The median postoperative creatinine was 116 μmol/L (79-645 μmol/L) with 2 patients needing dialysis. The postoperative pathology revealed that renal clear cell carcinoma in 10 cases, papillary carcinoma in 5 cases, urothelial carcinoma in 1 case and fusiform cell sarcoma in 1 case. During the median follow-up of 8 (1-28) months, 1 patient died during perioperative period, 1 patient died from multiple metastasis in 9 months postoperatively, 3 patients found distant metastasis and 2 cases remained lower extremity edema after operation.

CONCLUSION

The segmental resection of the vena cava may be a good choice for non-metastatic renal tumors with tumor thrombus invading vena cava. The short term follow-up results revealed a satisfactory safety and feasibility.

目的

探讨腔静脉节段性切除术的安全性及围手术期经验。

方法

2015年5月至2017年7月，北京大学第三医院收治92例伴有静脉瘤栓的肾肿瘤患者，其中17例因肾肿瘤伴瘤栓侵犯腔静脉而行肾切除术并切除受侵腔静脉。术前特征包括男性15例，女性2例，平均年龄（59.2±12.9）岁（31 - 84岁），左侧6例，右侧11例，肾肿瘤平均直径（9.1±3.7）cm（3 - 14.5 cm）。

结果

该组17例患者中，5例经腹腔镜行腔静脉切除术（包括2例中转开放），12例经开放手术（包括2例体外循环）。平均手术时间为（430.4±120.7）分钟（284 - 694分钟），平均术中出血量为（2918.8±2608.2）毫升（300 - 10000毫升）。自下而上横断腔静脉。腔静脉内瘤栓中位长度为10厘米（3 - 21厘米）。根据Clavien系统，11例患者出现术后并发症，其中Ⅰ级1例，Ⅱ级7例，Ⅳ级2例，Ⅴ级1例。术后肌酐中位值为116微摩尔/升（79 - 645微摩尔/升），2例患者需要透析。术后病理显示肾透明细胞癌10例，乳头状癌5例，尿路上皮癌1例，梭形细胞肉瘤1例。中位随访8（1 - 28）个月期间，1例患者围手术期死亡，1例患者术后9个月因多发转移死亡，3例患者出现远处转移，2例患者术后仍有下肢水肿。