Christmas T J, Smith G L, Kooner R
Department of Urology, Charing Cross Hospital, London. UK.
Eur J Surg Oncol. 1998 Aug;24(4):292-7. doi: 10.1016/s0748-7983(98)80009-7.
Complete excision of nodal masses during post-chemotherapy retroperitoneal lymph-node dissection (RPLND) for metastatic non-seminomatous germ-cell tumours (NSGCT) of the testis often requires vascular surgical intervention. We report our experience of vascular interventions and complications in a large series of men undergoing postchemotherapy RPLND.
A retrospective review of vascular interventions during post-chemotherapy RPLND in 98 patients was undertaken (103 procedures).
Macroscopic tumour clearance was complete in 95/98 men (97%). Vascular intervention was required in all cases. Major complications included acute tubular necrosis in one patient who had undergone left nephrectomy and extensive dissection around the right renal artery, progressive atrophy of the ipsilateral kidney in three men and a colonic stricture and associated colocutaneous fistula in one patient after division of the inferior mesenteric artery. Iliac and femoral venous thrombosis developed in both patients in whom the inferior vena cava (IVC) was excised and in one patient after partial IVC excision. Eight of the 98 patients have died. No late vascular complications have occurred to date.
Complete tumour clearance can be achieved in most post-chemotherapy RPLNDs but invariably involves vascular intervention. Metastatic NSGCT should be treated by surgeons with the ability to undertake the vascular procedures required.
对于睾丸转移性非精原细胞瘤性生殖细胞肿瘤（NSGCT）患者，在化疗后进行腹膜后淋巴结清扫术（RPLND）时，要完全切除淋巴结肿块往往需要血管外科干预。我们报告了大量接受化疗后RPLND患者的血管干预及并发症情况。
对98例患者（共103例手术）化疗后RPLND期间的血管干预进行回顾性分析。
98例患者中有95例（97%）实现了肉眼可见肿瘤的完全清除。所有病例均需要进行血管干预。主要并发症包括1例接受左肾切除术且右肾动脉周围广泛解剖的患者发生急性肾小管坏死，3例患者同侧肾脏进行性萎缩，1例患者在肠系膜下动脉离断后出现结肠狭窄及相关结肠皮肤瘘。2例切除下腔静脉（IVC）的患者和1例部分切除IVC的患者发生髂股静脉血栓形成。98例患者中有8例死亡。目前尚未出现晚期血管并发症。
大多数化疗后RPLND能够实现肿瘤的完全清除，但这不可避免地需要血管干预。转移性NSGCT应由具备进行所需血管手术能力的外科医生进行治疗。
