Vicente Prados E J, Tallada Buñuel M, Pastor J, Martínez Morcillo A, Cozar Olmo J M, Espejo Maldonado E, Pedrajas de Torres G
Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, España.
Arch Esp Urol. 1998 Jan-Feb;51(1):35-41.
Renal adenocarcinoma is characterized by marked venotropism; 20-49% show extension into the main renal vein and 4-19% into the vena cava. The present study analyzes the different diagnostic methods to evaluate the vascular involvement by renal carcinoma and presents the results achieved by total segmental cavectomy with ligation of the left renal vein and without vena caval reanastomosis.
Three patients (two males, one female) underwent total segmental cavectomy with ligation of the left renal vein in our Service over the last 10 years. A bilateral subcostal approach with access to the large vessels was utilized in all three cases. The superior and inferior renal vena cava were exposed and the hepatic veins were ligated at the level of the intrahepatic segment. Incision of the vena cava was performed, the thrombus was removed and the renal vessels were ligated. The proximal and distal segments of the vena cava were ligated after cavectomy. In the third patient, intrahepatic extension of the thrombus required the use of a temporary filter for the proximal segment of the vena cava.
The early postoperative course was satisfactory; adequate renal function was maintained and no problems with venous return were observed. Of the diagnostic methods analyzed, MRI was found to be the most useful. A relationship was found between survival and the pathological stage and the presence or absence of lymph node metastasis.
Total segmental cavectomy without reanastomosis and with ligation of the left renal vein appears to be a feasible technique which achieves good results. MRI is the diagnostic method of choice in the evaluation of vascular tumor extension.
肾腺癌的特点是明显的静脉趋向性；20% - 49%的病例显示肿瘤延伸至肾主静脉，4% - 19%延伸至下腔静脉。本研究分析了评估肾癌血管受累情况的不同诊断方法，并展示了通过左肾静脉结扎及下腔静脉不进行再吻合的全节段腔静脉切除术所取得的结果。
在过去10年中，我们科室有3例患者（2例男性，1例女性）接受了左肾静脉结扎的全节段腔静脉切除术。所有3例均采用双侧肋下切口以暴露大血管。暴露肾上下腔静脉，并在肝内段水平结扎肝静脉。切开腔静脉，清除血栓并结扎肾血管。腔静脉切除术后结扎腔静脉的近端和远端。在第3例患者中，由于血栓的肝内延伸，需要对腔静脉近端使用临时滤器。
术后早期过程令人满意；肾功能维持良好，未观察到静脉回流问题。在所分析的诊断方法中，MRI被认为是最有用的。发现生存与病理分期以及有无淋巴结转移之间存在关联。
不进行再吻合且结扎左肾静脉的全节段腔静脉切除术似乎是一种可行的技术，能取得良好效果。MRI是评估血管肿瘤延伸的首选诊断方法。
