Zhuo Liu, Guodong Zhu, Xun Zhao, Shiying Tang, Peng Hong, Li Zhang, Liwei Li, Shudong Zhang, Guoliang Wang, Xiaojun Tian, Cheng Liu, Hongxian Zhang, Lulin Ma
Urology Department of Peking University Third Hospital, Beijing, 100083, China.
Ultrasound Diagnosis Department of Peking University Third Hospital, Beijing, 100083, China.
BMC Surg. 2020 Jun 5;20(1):120. doi: 10.1186/s12893-020-00769-w.
To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombus.
We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.
There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 min, with an average of (6.8 ± 3.2) minutes. The mean time of IVC occlusion was (19.4 ± 4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ± 21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ± 144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease.
This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.
探讨一种改良手术技术的安全性和有效性，该技术可缩短左肾癌合并梅奥II至IV级下腔静脉（IVC）肿瘤血栓患者的肾缺血时间。
回顾性分析2015年2月至2019年7月14例左肾细胞癌（RCC）合并梅奥II至IV级IVC肿瘤血栓患者的临床资料。术前影像学检查显示肿瘤血栓无明显侵犯血管壁迹象。手术中，在阻断右肾动脉、右肾静脉和IVC远端后，使用球囊导管将肿瘤血栓从IVC完全取出。用Satinsky钳关闭IVC切口使IVC部分阻断。然后松开右肾动脉和右肾静脉。连续缝合IVC切口。最后，松开Satinsky钳和IVC远端的阻断带。
梅奥II级8例（57.1%），梅奥III级3例（21.4%），梅奥IV级3例（21.4%）。14例患者手术均成功完成。完全腹腔镜手术2例（14.3%），开放手术8例（57.1%），腹腔镜中转开放手术4例（28.6%）。右肾动脉和静脉阻断时间（肾缺血时间）为3至15分钟，平均（6.8±3.2）分钟。IVC平均阻断时间为（19.4±4.9）分钟。术前肌酐为66至130μmol/L，平均（96.6±21.2）μmol/L。术后1周，血清肌酐为64至632μmol/L，平均（132.4±144.9）μmol/L。14例中5例（42.9%）有早期术后并发症。14例患者中有1例在围手术期死亡，其余13例患者的中位随访时间为10个月（范围：4至29个月）。14例中有5例（35.7%）死于疾病。
这种改良手术方法在缩短左肾癌合并梅奥II至IV级IVC肿瘤血栓患者的肾缺血时间方面相对安全有效。
