Daum R, Roth H, Zachariou Z
Department of Pediatric Surgery, University of Heidelberg, Germany.
Eur J Pediatr Surg. 1994 Feb;4(1):16-20. doi: 10.1055/s-2008-1066059.
Although operative treatment of Wilms' tumors has become more straightforward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement by the tumor can cause serious problems at operation. These problems can be more easily managed if they have been identified pre-operatively and the level of the intravascular tumor thrombus has been defined. In this study we propose a classification of intravascular involvement of Wilms' tumors suggesting the clinical consequences and operative strategy. In our series of 84 patients we treated 7 (8.3%) with preoperatively diagnosed intracaval tumor thrombus using ultrasound as the most sensitive non-invasive diagnostic technique. The surgical therapy depends on the stage; stage III and stage IV should be operated in cooperation with the cardiovascular surgeon in deep hypothermic circular arrest.
尽管由于术前治疗的进展和精确诊断，肾母细胞瘤的手术治疗变得更加直接，但肿瘤侵犯血管在手术时可导致严重问题。如果术前已识别出这些问题并明确了血管内肿瘤血栓的水平，那么这些问题将更容易处理。在本研究中，我们提出了一种肾母细胞瘤血管内侵犯的分类方法，提示其临床后果和手术策略。在我们的84例患者系列中，我们使用超声作为最敏感的非侵入性诊断技术，治疗了7例（8.3%）术前诊断为腔静脉内肿瘤血栓的患者。手术治疗取决于分期；III期和IV期应在心血管外科医生的配合下，在深低温停循环下进行手术。
