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目的:探讨腹膜后恶性肿瘤并下腔静脉瘤栓的治疗方法。方法:对16例腹膜后恶性肿瘤并下腔静脉瘤栓患者的临床资料进行分析。结果:16例中肾癌9例,肾母细胞瘤3例,肾上腺皮质癌2例,腹膜后恶性神经鞘瘤1例,左肾上腺内胚窦瘤1例。按NEVES和ZINCKE的方法对瘤栓进行分型,Ⅰ型2例、Ⅱ型2例、Ⅲ型7例、Ⅳ型5例。5例因全身情况差或合并症多而未作治疗。9例行恶性肿瘤根治术,同时切除下腔静脉瘤栓;2例仅行恶性肿瘤根治术,未对瘤栓作处理,手术均顺利,未发生癌栓脱落情况,无术中死亡病例。术后第2日出现脑血管栓塞致暂时性失明1例,术后4个月出现下肢静脉血栓栓塞1例(均为未对瘤栓作处理患者),术后3个月发生肠梗阻1例(为已切除下腔静脉瘤栓患者),均经保守治疗后好转。1例腹膜后内胚窦瘤患儿于切除瘤栓后5个月瘤栓复发,经化学治疗后下腔静脉瘤栓退缩。全部病例随访3～50个月。未经任何治疗的5例均于3个月内死亡,死于心和肺功能衰竭1例、尿毒症1例、瘤栓脱落致肺栓塞3例。11例经手术治疗患者中7例于术后4～50个月死亡,均死于心力衰竭和肺衰竭。存活的4例均为进行了包括肿瘤根治性手术、取瘤栓、术后定期化学治疗等综合治疗的患者(其中3例TNM分期Ⅲ～Ⅳ期)。结论:对腹膜后恶性肿瘤并下腔静脉瘤栓的病例宜采用以手术为主的综合治疗。
Objective: To investigate the treatment of retroperitoneal malignant tumor and inferior vena cava tumor suppository. Methods: The clinical data of 16 patients with retroperitoneal malignant tumor and inferior vena cava tumor thrombus were analyzed. Results: There were 9 cases of renal cell carcinoma in 16 cases, 3 cases of nephroblastoma, 2 cases of adrenocortical carcinoma, 1 case of retroperitoneal schwannoma, 1 case of left adrenal endodermal sinus tumor. According to the method of NEVES and ZINCKE, the tumor suppository was typed in 2 cases of type Ⅰ, 2 cases of type Ⅱ, 7 cases of type Ⅲ and 5 cases of type Ⅳ. Five cases were not treated because of poor general condition or comorbidities. Nine patients underwent radical resection of malignant tumor while resection of inferior vena cava tumor thrombus. Two patients underwent radical resection of malignant tumor without treatment of tumor thrombus, and the operation was successful. There was no case of tumor thrombus shedding and no intraoperative death. One case of transient blindness caused by cerebrovascular embolism on the second day after operation and one case of venous thromboembolism of the lower extremities 4 months after surgery (all patients who had not treated the tumor thrombus). One case of intestinal obstruction occurred 3 months after operation (For patients with resected inferior vena cava tumor thrombus), after conservative treatment improved. One case of retroperitoneal endodermal sinus tumor in children after tumor resection tumor embolization 5 months tumor recurrence after chemotherapy cuff rupture. All cases were followed up for 3 to 50 months. None of the 5 patients died within 3 months, died of heart and lung failure in 1 case, uremia in 1 case, tumor embolization to pulmonary embolism in 3 cases. Seven of the 11 surgically treated patients died 4 to 50 months postoperatively, both of whom died of heart failure and pulmonary failure. All 4 patients survived were patients who underwent radical surgery, tumor embolization and regular chemotherapy after operation. Among them, 3 patients underwent TNM stage Ⅲ ~ Ⅳ. Conclusion: For patients with retroperitoneal malignant tumor and inferior vena cava tumor thrombus, surgical treatment should be adopted.