Tang Guangxu, Wang Hebin, Liu Luyao, Ji Chundong, Yi Junqiu, Zhang Lei, Liu Shiying
Intensive Care Unit, The Affiliated Hospital of Panzhihua University, Panzhihua, 617000, PR China.
Department of Hepatology, The Affiliated Hospital of Panzhihua University, Panzhihua, 617000, PR China.
Heliyon. 2025 Feb 11;11(4):e42645. doi: 10.1016/j.heliyon.2025.e42645. eCollection 2025 Feb 28.
Giant abdominal tumors exceeding 10 cm in diameter are rare and often involve several critical organs and vascular structures. The primary treatment is surgical excision, which presents substantial challenges, including organ preservation, hemorrhage control, and intact tumor removal.
We present a 46-year-old male with a massive abdominal mass invading the right kidney and inferior vena cava (IVC). To address this, we developed a novel technique using continuous renal replacement therapy (CRRT) renal vein (RV) shunt procedure. A temporary dialysis catheter was placed in the internal jugular vein to divert blood from the left RV to the superior vena cava. After excising the mass and part of the IVC, an artificial blood vessel was used to reconnect the left RV to the IVC. The urine output of the patient was normal during the surgery, and the renal function remained normal during the 343 days' follow-up period. This approach streamlined the surgical procedures, operating time, blood loss, and avoided systemic heparinization through regional citrate anticoagulation.
This innovative surgical technique is particularly effective for complex cases requiring simultaneous occlusion of the IVC and both RVs. It enhances patient safety and outcomes and has significant potential for broader application in urology and general surgery. This case highlights the value of surgical innovation in overcoming complex challenges and provides valuable insights for the medical community.
直径超过10厘米的巨大腹部肿瘤较为罕见，且常累及多个重要器官和血管结构。主要治疗方法是手术切除，这带来了诸多重大挑战，包括器官保留、出血控制以及完整切除肿瘤。
我们报告一例46岁男性，患有巨大腹部肿块，侵犯右肾和下腔静脉（IVC）。为解决此问题，我们开发了一种使用连续性肾脏替代疗法（CRRT）肾静脉（RV）分流术的新技术。在颈内静脉置入一根临时透析导管，将血液从左肾静脉分流至上腔静脉。切除肿块及部分下腔静脉后，使用人工血管将左肾静脉重新连接至下腔静脉。手术过程中患者尿量正常，在343天的随访期内肾功能保持正常。这种方法简化了手术步骤、缩短了手术时间、减少了失血量，并通过局部枸橼酸盐抗凝避免了全身肝素化。
这种创新的手术技术对于需要同时阻断下腔静脉和双侧肾静脉的复杂病例特别有效。它提高了患者的安全性和治疗效果，在泌尿外科和普通外科具有广泛应用的巨大潜力。本病例突出了手术创新在克服复杂挑战方面的价值，并为医学界提供了宝贵的见解。
