Martínez-Ibáñez V, Sánchez de Toledo J, De Diego M, Castellote A, Sábado C, Javier G, Marqués A, Boix-Ochoa J
Hospital Infantil Valle Hebrón, Department of Paediatric Surgery, Barcelona, Spain.
Med Pediatr Oncol. 1996 Apr;26(4):268-71. doi: 10.1002/(SICI)1096-911X(199604)26:4<268::AID-MPO10>3.0.CO;2-B.
Since Gross established the basic rules for nephrectomy in Wilms' tumour (WT) in 1953, the management of nephroblastoma has been more straightforward. However, some cases with intravascular involvement, currently detected by ultrasound (US), may represent a daunting challenge for the surgeon. Inferior vena cava with tumour thrombus, induced by WT, can be asymptomatic and, if undetected, can contribute to poorer prognosis for two main reasons: possible neoplastic cells inside the thrombus and higher morbidity risk of surgery. From 1979 to 1993, 81 WT were studied by routine US. Intracaval thrombosis was diagnosed in four (5%), in one of which the thrombus extended to the right atrium. In our experience, the surgical strategy in each of the four cases (100% survival) depended on the length of the thrombus and whether or not it infiltrated the vena cava wall. If the thrombus can be easily removed: complete resection. However, in cases of atrial thrombus, and more particularly if the thrombus involves the intima, we suggest the thrombus not be touched since the problem may be solved by preoperative and postoperative chemotherapy. Thus the favourable prognosis would be maintained and superfluous risky surgery avoided.
自1953年格罗斯确立了肾母细胞瘤（WT）肾切除术的基本规则以来，肾母细胞瘤的治疗变得更加直接明了。然而，目前通过超声（US）检测到的一些存在血管内受累的病例，可能对外科医生构成严峻挑战。WT引发的伴有肿瘤血栓的下腔静脉可能没有症状，如果未被发现，可能导致预后较差，主要有两个原因：血栓内可能存在肿瘤细胞以及手术的发病风险较高。1979年至1993年，对81例WT进行了常规超声检查。诊断出4例（5%）存在腔静脉内血栓形成，其中1例血栓延伸至右心房。根据我们的经验，这4例患者（100%存活）的手术策略取决于血栓的长度以及它是否浸润腔静脉壁。如果血栓能够轻松切除：则进行完整切除。然而，对于心房血栓的情况，尤其是如果血栓累及内膜，我们建议不要触碰血栓，因为术前和术后化疗可能解决问题。这样既能维持良好的预后，又能避免不必要的高风险手术。
