Marshall F F, Reitz B A
J Urol. 1985 Feb;133(2):266-8. doi: 10.1016/s0022-5347(17)48912-9.
Supradiaphragmatic extension of tumor thrombus from a renal cell carcinoma presents a major surgical challenge. The use of cardiopulmonary bypass, hypothermia and cardiac arrest with temporary exsanguination has allowed for successful surgical excision of these tumors. A renal cell carcinoma on the right side with a supradiaphragmatic tumor thrombus still may only partially occlude the vena cava. The collateral venous circulation of the left renal vein may be developed poorly and a pericardial patch can allow successful reconstruction of the inferior vena cava. If the tumor arises on the left side continued venous drainage of the right kidney is mandatory to prevent venous infarction of the right kidney. The entire vena cava also might be reconstructed theoretically with pericardium.
肾细胞癌的肿瘤血栓膈上延伸带来了重大的手术挑战。使用体外循环、低温和心脏停搏并临时放血已使这些肿瘤得以成功手术切除。右侧伴有膈上肿瘤血栓的肾细胞癌可能仅部分阻塞腔静脉。左肾静脉的侧支静脉循环可能发育不良，心包补片可成功重建下腔静脉。如果肿瘤发生在左侧，右肾持续的静脉引流是必要的，以防止右肾静脉梗死。理论上整个腔静脉也可用心包重建。
