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目的总结与探讨肾癌伴下腔静脉癌栓手术治疗的经验和临床应用价值。方法回顾性分析2006年4月～2010年10月行R CC根治术中联合IVC取栓、血管重建术7例患者的临床资料:男性6例,女性1例,中位年龄52岁;Mayo Clinic的IVC癌栓分类法分为:0级0例,Ⅰ级1例,Ⅱ级2例,Ⅲ级3例,Ⅳ级1例。病理分期(Robson分期):Ⅲ期5例,Ⅳ期2例。结果 7例均成功行肾癌根治性切除、下腔静脉癌栓取出及即时下腔静脉修复重建。其中,5例行单纯连续缝合IVC切口修复;Ⅲ期中IVC壁缺损较大的两例分别用自体肝镰状韧带补片修复一例,行端端吻合一例。无围手术期死亡及严重并发症发生。随访5个月～5年,4例于术后8～9个月肿瘤复发死亡。2例3年无瘤生存。1例失访。结论对无淋巴结和远处转移的肾癌伴下腔静脉癌栓患者,在行RCC根治性切除的同时,积极地进行联合IVC取栓、切除受侵静脉壁和IVC重建,能够提高远期存活率。并指出:普外科、泌尿外科、血管外科、心脏外科、麻醉科等多学科的密切合作对保证此手术的成功至关重要。
Objective To summarize and discuss the experience and clinical value of surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Methods The clinical data of 7 patients undergoing RCC combined with IVC thrombectomy and revascularization from April 2006 to October 2010 were analyzed retrospectively: 6 males and 1 female, with a median age of 52 years; Mayo Clinic The IVC tumor thrombosis classification is divided into: 0 0 cases, Ⅰ in 1 case, Ⅱ in 2 cases, Ⅲ in 3 cases, Ⅳ in 1 case. Pathological staging (Robson staging): 5 cases of stage Ⅲ, 2 cases of stage Ⅳ. Results All the 7 cases were successfully performed radical resection of renal cell carcinoma, removal of inferior vena cava tumor emboli and immediate reconstruction of inferior vena cava. Among them, 5 cases were treated with simple continuous suture IVC incision. In the third stage, two cases with large IVC wall defect were repaired with autologous liver sickle ligament patch, one end-to-end anastomosis. No perioperative deaths and serious complications occurred. Followed up for 5 months to 5 years, 4 patients died of tumor recurrence 8 to 9 months after operation. 2 cases 3-year disease-free survival. 1 patient lost. Conclusions In patients with renal cell carcinoma and lymphnode tumor without lymph node metastasis and distant metastasis, radical resection of the RCC combined with IVC thrombectomy and excision of the invading IVC and IVC can improve long-term survival rate. And pointed out: General surgery, urology, vascular surgery, cardiac surgery, anesthesiology and other multidisciplinary close cooperation to ensure the success of this operation is essential.