Nakamoto T, Igawa M, Mitani S, Usui A, Usui T
Department of Urology, Hiroshima University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1994 Mar;85(3):440-5. doi: 10.5980/jpnjurol1989.85.440.
Between 1985 and 1992, 9 patients (6 men and 3 women), 50-76 years old (mean age 63.6), underwent radical nephrectomy and removal of the tumor thrombus for the treatment of renal cell carcinoma extending into the vena cava at the Department of Urology, Hiroshima University Hospital. Seven tumors were located in the right kidney and two in the left kidney. Three tumor thrombi extended into the vena cava within 2 cm (level 1 according to the Novick's classification), 2 extended into the infrahepatic vena cava (level 2), 2 extended into the suprahepatic vena cava (level 3), and other 2 extended into the right atrium (level 4). Two patients had distant metastases preoperatively. The tumor thrombi at the level 1 were removed by venacavotomy with a short duration of surgery and a small amount of blood loss, while in those at the level of 2 or 3, both the duration of surgery and the amount of blood loss increased because the mobilization of the liver needed to remove the thrombi. For removing tumor thrombi at the level 4, cardiopulmonary bypass and deep hypothermic circulatory arrest were applied, resulting in longer duration of surgery but less amounts of blood loss than those at the level 2 or 3. Postoperatively, 2 patients had a renal insufficiency and another 2 had a liver dysfunction. One operative death occurred in this series because of pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
1985年至1992年间，广岛大学医院泌尿外科对9例患者（6例男性和3例女性）进行了根治性肾切除术并切除肿瘤血栓，以治疗延伸至腔静脉的肾细胞癌。患者年龄在50至76岁之间（平均年龄63.6岁）。7个肿瘤位于右肾，2个位于左肾。3个肿瘤血栓延伸至腔静脉内2厘米处（根据诺维克分类为1级），2个延伸至肝下腔静脉（2级），2个延伸至上肝腔静脉（3级），另外2个延伸至右心房（4级）。2例患者术前有远处转移。1级肿瘤血栓通过腔静脉切开术切除，手术时间短，失血量少；而对于2级或3级的肿瘤血栓，由于需要移动肝脏来切除血栓，手术时间和失血量均增加。对于切除4级肿瘤血栓，采用了体外循环和深低温循环停止，导致手术时间较长，但失血量比2级或3级少。术后，2例患者出现肾功能不全，另外2例出现肝功能障碍。本系列中有1例手术死亡，原因是肺栓塞。（摘要截短至250字）
