Department of Urology, Peking University Third Hospital, Haidian District, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.
Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China.
BMC Surg. 2022 Nov 4;22(1):377. doi: 10.1186/s12893-022-01821-7.
We aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique.
Overall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example).
Compared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143-245) min vs. 148 (IQR 108-261) min, p = 0.86], IVC clamping time [18 (IQR 12-20) min vs. 20 (IQR 14-23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100-800) mL vs. 500 (IQR 175-738) mL, p = 0.51] between both groups. During a 16-month (range, 15-23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group.
The modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.
我们旨在比较机器人辅助根治性肾切除术（RARN）联合下腔静脉（IVC）血栓切除术时斜向夹闭技术与传统技术的肿瘤学结果，并探讨斜向夹闭技术的安全性和有效性。
2019 年 8 月至 2020 年 6 月，共有 21 例肾细胞癌（RCC）合并 IVC 肿瘤血栓（TT）患者入组我院。所有患者均接受 RARN 联合 IVC 血栓切除术，其中 11 例采用 IVC 斜向夹闭技术，10 例采用传统夹闭技术。斜向夹闭技术是指使用血管止血带或血管夹从右肾静脉的上顶角到左肾静脉的下顶角进行斜向阻断（以左肾癌合并 IVCTT 为例）。
与传统组患者相比，斜向组患者在随访时（3 个月）的血清肌酐水平更低（95 ± 21.1 比 131 ± 30.7 μmol/L，P = 0.03）。两组手术时间[149（IQR 143-245）min 比 148（IQR 108-261）min，p = 0.86]、IVC 阻断时间[18（IQR 12-20）min 比 20（IQR 14-23）min，p = 0.41]和估计术中出血量[300（IQR 100-800）mL 比 500（IQR 175-738）mL，p = 0.51]差异均无统计学意义。在 16 个月（范围 15-23 个月）的随访期间，斜向组有 2 例进展，传统组有 3 例进展。
改良的 IVC 斜向夹闭技术在 RARN 联合 IVC 血栓切除术中较为安全有效。IVC 斜向夹闭技术可能在保护肾功能方面发挥作用。
