Li Xiaohang, Li Baifeng, Zhang Na, Wang Fengshan, Zhang Chengshuo, Sun Ning, Zhang Jialin
Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
Front Surg. 2022 Jul 26;9:913927. doi: 10.3389/fsurg.2022.913927. eCollection 2022.
Leiomyosarcoma of the inferior vena cava (IVC) was a rather rare disease with the characteristics of invading the adjacent viscera. Surgical resection is the only potential curative treatment, and radiation therapy and chemotherapy for leiomyosarcoma are not definite. There is few literature reporting the leiomyosarcoma of the IVC.
A previously healthy 64-year-old female was admitted to the First Affiliated Hospital of China Medical University with the complaint of right lower quadrant abdominal pain for almost three years and worsening with a radiating ache in the waist recently. Contrast-enhanced computed tomography(CT) scans revealed a large (7.8 cm5.5 cm5.0 cm) irregular hypodense retroperitoneal mass with heterogeneous enhancement and invasion of the IVC, and the right ureter was compressed with proximal ureteral dilatation and hydrops. Three-dimensional CT of the IVC revealed that the IVC was encircled by the tumor with moderate invasion. During the operation, the tumor was resected with the IVC (from the suprarenal to infrarenal segment), the right kidney with ureter, and the duodenum seromuscular layer. As the left renal vein was involved, it was also partly resected. IVC reconstruction was performed with the interposition of a 20 mm diameter polytetrafluoroethylene (PTFE) prosthesis, and the right renal vein was anastomosed between the left renal vein and the reconstructed IVC to guarantee the left renal vein reflux. The patient had an uneventful recovery process with normal renal function after the operation. However, follow-up CT indicated that the left renal vein was blocked two weeks after the surgery. The patient was discharged two weeks after the operation. She continues well and has no evidence of disease fourteen months after the surgery.
Wide excision of the tumor with the IVC is the main treatment for leiomyosarcoma of the IVC. IVC reconstruction with prosthetic PTFE grafts is recommended. When the left renal vein is partly resected due to involvement of the tumor, reconstruction of left renal vein should also be performed to avoid renal impairment. If the right renal vein does not show tumor involvement, the resected right renal vein can be used to reconstruct the left renal vein.
下腔静脉平滑肌肉瘤是一种较为罕见的疾病，具有侵犯相邻脏器的特征。手术切除是唯一可能治愈的治疗方法，而平滑肌肉瘤的放疗和化疗效果尚不明确。关于下腔静脉平滑肌肉瘤的文献报道较少。
一名64岁既往健康的女性因右下腹痛近三年，近期加重并伴有腰部放射性疼痛入住中国医科大学附属第一医院。增强计算机断层扫描（CT）显示一个大的（7.8 cm×5.5 cm×5.0 cm）不规则低密度腹膜后肿块，强化不均匀，侵犯下腔静脉，右输尿管受压，近端输尿管扩张积水。下腔静脉三维CT显示下腔静脉被肿瘤中度侵犯环绕。手术中，将肿瘤与下腔静脉（从肾上腺段至肾下段）、右肾及输尿管、十二指肠浆肌层一并切除。由于左肾静脉受累，也部分切除。采用直径20 mm的聚四氟乙烯（PTFE）人工血管进行下腔静脉重建，右肾静脉吻合于左肾静脉与重建的下腔静脉之间，以保证左肾静脉回流。术后患者恢复顺利，肾功能正常。然而，术后两周的随访CT显示左肾静脉堵塞。患者术后两周出院。术后14个月她情况良好，无疾病迹象。
下腔静脉平滑肌肉瘤的主要治疗方法是广泛切除肿瘤及受累的下腔静脉。建议采用PTFE人工血管进行下腔静脉重建。当因肿瘤累及而部分切除左肾静脉时，也应进行左肾静脉重建以避免肾功能损害。如果右肾静脉未受肿瘤侵犯，可利用切除的右肾静脉重建左肾静脉。
