Takigawa H, Kagawa S, Nakamura S, Yano M, Kawanishi Y, Kato I
Department of Urology, School of Medicine, Tokushima University.
Hinyokika Kiyo. 1987 Jun;33(6):936-9.
A case of fibrosarcoma of the kidney extending into the inferior vena cava with intraoperative development of massive neoplastic pulmonary emboli is reported. A 38-year-old man was admitted to our hospital because of right renal tumor with gross hematuria, right flank pain and abdominal tumor. Inferior venacavograms and computerized tomography demonstrated almost total occlusion of the abdominal part of the vena cava by tumor thrombi. No signs of inferior vena caval involvement were present. Intraoperative pulmonary neoplastic emboli suddenly occurred after right nephrectomy was performed. Immediately, pulmonary thrombectomy was performed with extra-corporeal circulation. Postoperatively, pulse, blood pressure and ventilation were stable, but the patient remained unconscious and neurologic signs gradually deteriorated. Computerized tomography of the brain showed diffuse brain edema and infarctions. The patient died of cardiopulmonary insufficiency with multiple pulmonary metastasis 8 months postoperatively. We emphasize the risk of fragmentation and migration of the tumor thrombi during surgical treatment of neoplasm of the kidney invading the inferior vena cava.
本文报道了一例肾纤维肉瘤侵犯下腔静脉，术中出现大量肿瘤性肺栓塞的病例。一名38岁男性因右肾肿瘤伴肉眼血尿、右侧腰痛及腹部肿块入院。下腔静脉造影和计算机断层扫描显示肿瘤血栓几乎完全阻塞下腔静脉腹部段。未发现下腔静脉受累迹象。右肾切除术后突然发生术中肺肿瘤栓塞。随即在体外循环下行肺血栓切除术。术后，脉搏、血压和通气稳定，但患者仍昏迷，神经体征逐渐恶化。脑部计算机断层扫描显示弥漫性脑水肿和梗死。患者术后8个月死于心肺功能不全伴多发肺转移。我们强调在手术治疗侵犯下腔静脉的肾肿瘤时，肿瘤血栓碎裂和迁移的风险。
