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目的:探讨左肾癌伴有不同分级肾静脉瘤栓患者经后腹腔途径腹腔镜左肾癌根治术的可行性。方法:7例左肾占位伴左肾静脉瘤栓患者,增强CT显示7例肿物不均匀强化,并伴有肾静脉内充盈缺损,均在全麻下行后腹腔镜左肾癌根治术。术中放置4个穿刺套管针,游离腹主动脉和肾动脉后,Hem-o-lok结扎切断肾动脉,游离肾静脉后判断7例瘤栓均为非附壁瘤栓,上托肾脏,于肾静脉近下腔静脉处Hem-o-lok结扎切断肾静脉,完整切除肾脏及瘤栓。我们根据左肾静脉瘤栓长度进行分级,讨论不同分级患者手术难点及可行性。结果:7例手术均获成功,术后恢复良好。病理诊断为肾透明细胞癌6例,嫌色细胞癌1例。术后随访8个月(1～18个月),未见肿瘤复发和转移。结论:对于选择性病例伴有不同分级的肾静脉瘤栓的左肾癌行经后腹腔途径腹腔镜左肾癌根治术可行,但随瘤栓分级增加手术难度增大。
Objective: To investigate the feasibility of laparoscopic radical nephrectomy with retroperitoneal laparoscopic approach in patients with left renal cell carcinoma and different grades of renal vein thrombus. Methods: In 7 patients with left renal involvement and left renal vein thrombosis, enhanced CT showed uneven enhancement of 7 masses accompanied with filling defect of renal vein. All patients underwent laparoscopic radical nephrectomy under general anesthesia. Intraoperative placement of four puncture trocar, free abdominal aorta and renal artery, Hem-o-lok ligation of the renal artery ligation, free renal vein to determine the seven cases of non-pulmonary thrombus suppository tumor thrombus on the kidney, In renal vein near the inferior vena cava Hem-o-lok ligation of the renal vein cut, complete removal of the kidney and tumor embolus. We classify according to the length of the left renal vein tumor thrombus and discuss the difficulty and feasibility of surgery in different grading patients. Results: All the 7 cases were successful and recovered well after operation. Pathological diagnosis of renal clear cell carcinoma in 6 cases, 1 case of chromophobe. All the patients were followed up for 8 months (1 ~ 18 months). No tumor recurrence and metastasis were found. Conclusion: For patients with selective renal failure treated with different grades of renal vein thrombosis, it is feasible to perform laparoscopic radical nephrectomy of the left renal cell carcinoma through retroperitoneal approach. However, it is more difficult to increase the tumor size with the increase of the tumor size.