Addeo Pietro, Moog Raphael, Paul Chloe, Imperiale Alessio, Baltzinger Philippe, de Mathelin Pierre
Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Hépatiques et Digestives, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
Pediatric surgery department, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
Ann Surg Oncol. 2025 Oct;32(10):7832-7833. doi: 10.1245/s10434-025-17639-5. Epub 2025 Jun 12.
In the case of tumors involving the infrarenal inferior vena cava (IVC), reimplantation of both renal veins is recommended to preserve renal function. The left renal vein can be ligated because of the collateral circulation through the gonadal and/or lumbar veins. On the contrary, right nephrectomy or reconstruction of the right renal vein (when not invaded) is mostly performed because the right kidney has no collateral vein circulation .
The patient had a paracaval paraganglioma infiltrating the infrarenal IVC. The confluence of both renal veins was infiltrated, and incomplete surgery had been performed previously. Preoperative imaging showed that the right renal vein was free from tumoral infiltration at the renal hilum. Surgery was performed via a midline incision. To avoid venous congestion a temporary venous shunt between the right renal vein and the portal vein was used. The IVC was resected en-bloc with the both renal veins and reconstructed by a 10 cm long, 20 mm diameter, ringed Goretex® tube. The right renal vein was reimplanted directly over the IVC tube. The left renal vein was anastomosed on the IVC tube by interposing a 5 cm long, 10 mm diameter, ringed Goretex® tube.
The postoperative course was uneventful. Long-term imaging showed permeability of the IVC and right renal vein reconstruction, but obstruction of the conduit used to replace the left renal vein, which was drained via the left gonadal vein. No tumoral recurrence was detected.
Resection of the infrarenal IVC with preservation of both renal veins can be feasible in selected cases. To avoid venous congestion, a temporary venous shunt between the right renal vein and the portal vein can be useful.
对于累及肾下下腔静脉（IVC）的肿瘤，建议重新植入双侧肾静脉以保留肾功能。由于存在通过性腺静脉和/或腰静脉的侧支循环，左肾静脉可以结扎。相反，大多施行右肾切除术或右肾静脉重建术（当未受侵犯时），因为右肾没有静脉侧支循环。
该患者患有腔静脉旁副神经节瘤，浸润肾下IVC。双侧肾静脉汇合处受浸润，且先前已进行了不完全手术。术前影像学检查显示右肾静脉在肾门处未受肿瘤浸润。手术通过中线切口进行。为避免静脉淤血，在右肾静脉和门静脉之间使用了临时静脉分流。将IVC与双侧肾静脉整块切除，并用一根10厘米长、直径20毫米的带环Goretex®管进行重建。右肾静脉直接重新植入IVC管上方。左肾静脉通过插入一根5厘米长、直径10毫米的带环Goretex®管与IVC管吻合。
术后过程顺利。长期影像学检查显示IVC通畅及右肾静脉重建，但用于替代左肾静脉的导管阻塞，通过左性腺静脉引流。未检测到肿瘤复发。
在特定病例中，切除肾下IVC并保留双侧肾静脉是可行的。为避免静脉淤血，右肾静脉与门静脉之间的临时静脉分流可能有用。
