Okada Y, Kumada K, Terachi T, Nishimura K, Tomoyoshi T, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
J Urol. 1996 Feb;155(2):444-6; discussion 447.
Inferior vena caval resection and its reconstruction are sometimes necessary when the inferior vena cava is extensively involved by a large and fixed tumor thrombus from renal cell carcinoma or other malignancies. We successfully replaced the inferior vena cava using tubular expanded polytetrafluoroethylene (Teflon) vascular grafts after en bloc removal of the tumor thrombus and inferior vena cava. We followed the patients long term and observed inferior vena caval patency.
The 3 men and 2 women ranged from 42 to 75 years old. The renal tumors were on the right side in 4 patients and asynchronously bilateral in 1. The suprarenal inferior vena cava was replaced in 3 patients and the infrarenal portion was replaced in 2. The expanded polytetrafluoroethylene tube grafts, 18 to 22 mm. in diameter and 5 to 12 cm. long, were externally stented in 3 patients and not stented in 2.
Followup ranged from 6 to 96 months (mean 58). Long-term patency of the graft was maintained in all patients. Of the patients 3 had no evidence of disease at 6 months and 2 died of recurrent tumor at 6 and 84 months.
Total replacement of the inferior vena cava using an expanded polytetrafluoroethylene tubular graft may offer a feasible method with good patency rates in the long term.
当肾细胞癌或其他恶性肿瘤的巨大固定肿瘤血栓广泛累及下腔静脉时，有时需要进行下腔静脉切除及其重建。我们在整块切除肿瘤血栓和下腔静脉后，成功地使用管状膨体聚四氟乙烯（特氟龙）血管移植物替换了下腔静脉。我们对患者进行了长期随访，并观察了下腔静脉的通畅情况。
3名男性和2名女性，年龄在42至75岁之间。4例患者的肾肿瘤位于右侧，1例为异步双侧性。3例患者替换了肾上段下腔静脉，2例患者替换了肾下段。膨体聚四氟乙烯管移植物直径为18至22毫米，长度为5至12厘米，3例患者进行了外部支架置入，2例未置入。
随访时间为6至96个月（平均58个月）。所有患者的移植物均保持长期通畅。3例患者在6个月时无疾病证据，2例患者分别在6个月和84个月时死于肿瘤复发。
使用膨体聚四氟乙烯管状移植物完全替换下腔静脉可能提供一种可行的方法，长期通畅率良好。
