Habib F, McLorie G A, McKenna P H, Khoury A E, Churchill B M
Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 1993 Sep;150(3):933-5. doi: 10.1016/s0022-5347(17)35653-7.
Surgical treatment of Wilms tumor with vena caval and intracardiac extension is challenging, often requiring cardiopulmonary bypass. We report the response to preoperative chemotherapy in 3 patients following a protocol at our hospital. The tumor thrombus was limited to the inferior vena cava in 2 patients and extended to the right atrium in 1. All 3 patients had marked reduction or complete eradication of the venous thrombus, facilitating the final surgical procedure. The patients are disease-free 18 months to 7 years after the initial treatment. Our protocol involves initial radiographic staging followed by needle biopsy, chemotherapy, repeat radiographic staging, definitive resection and additional chemotherapy. Our results confirm the effectiveness of this approach, which appears to decrease morbidity associated with intracaval and intra-atrial tumor extension.
对于伴有腔静脉及心内扩展的肾母细胞瘤进行手术治疗具有挑战性，通常需要体外循环。我们报告了3例患者按照我院方案进行术前化疗后的反应。2例患者的肿瘤血栓局限于下腔静脉，1例扩展至右心房。所有3例患者的静脉血栓均显著缩小或完全清除，便于最终的手术操作。这些患者在初始治疗后18个月至7年无疾病复发。我们的方案包括初始影像学分期，随后进行穿刺活检、化疗、重复影像学分期、根治性切除及额外化疗。我们的结果证实了这种方法的有效性，它似乎降低了与腔静脉及心房内肿瘤扩展相关的发病率。
