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目的 :提高肾细胞癌 ( RCC)伴静脉癌栓的诊治效果。方法 :1996～ 1999年诊治 RCC伴静脉癌栓 6例 ,其中肾静脉型 1例 ,肝下型 3例 ,膈上型 2例 ,经磁共振成像 ( MRI)及彩色多普勒超声确诊 ,均行肾癌根治术加癌栓取出术。结果 :肾静脉型平均生存 36个月 ;肝下型 3例分别生存 2 5个月、4个月 (有局部淋巴结转移 )及 2 2个月 ,最终均死于远处转移 ;膈上型 1例 (伴肺转移 )术后 2个月死于远处转移 ,1例右心房癌栓者在取出癌栓开放血流时因呼吸及循环衰竭而死亡。结论 :MRI和彩色多普勒超声检查是目前诊断 RCC伴静脉癌栓的较好方法 ;对无淋巴结和远处转移者 ,手术应采取积极的态度 ,手术方式的选择取决于癌栓水平
Objective: To improve the diagnosis and treatment of renal cell carcinoma (RCC) with venous thrombosis. Methods: Six patients with RCC with venous thrombosis were diagnosed and treated from 1996 to 1999. Among them, 1 was renal vein type, 3 was subhepatic type and 2 was diaphragmatic type. Both of them were confirmed by MRI and color Doppler ultrasonography Radical nephrectomy plus tumor thrombectomy. Results: The average survival of the renal vein type was 36 months. In the subhepatic type, 3 patients survived 25 months, 4 months (with local lymph node metastasis) and 22 months respectively, eventually died of distant metastasis. Cases (with lung metastasis) died of distant metastases 2 months after surgery. One of the patients with right atrial cancer thrombus died of respiratory and circulatory failure when the open thrombus was removed. Conclusion: MRI and color Doppler ultrasonography are the better methods for diagnosing RCC with venous thrombosis. For those without lymph node and distant metastasis, the operation should take a positive attitude. The choice of surgical method depends on the level of tumor thrombus