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目的:提高肾癌下腔静脉癌栓的诊治水平。方法:回顾分析12例经手术及病理证实的肾癌下腔静脉癌栓患者的资料。结果:12例腔静脉癌栓均为膈下型,其中肾静脉型1例(8.3%),肝下型9例(75%),肝内型2例 (16.7%),无膈上型。彩超诊断腔静脉癌栓的准确率为66.7%(8/12),假阴性16.7%(2/12)。CT准确率83.3%(10/ 12),假阴性16.7%(2/12)。MRI准确率100%。术后3例失访,4例死于全身衰竭和肝转移,平均存活时间22个月,余 5例均健在,存活时间6-38个月,未见肿瘤转移征象。结论:MRI和彩色多普勒超声是目前诊断肾细胞癌伴静脉癌栓的较好方法。对无淋巴结和远处转移者,应采取积极手术的态度,手术方式取决于癌栓水平。
Objective: To improve diagnosis and treatment of IVC tumor thrombus in patients with renal cell carcinoma. Methods: Retrospective analysis of 12 cases of renal cell carcinoma of the inferior vena cava tumor thrombosis confirmed by surgery and pathology. Results: All the 12 cases of vena cava tumor thrombus were subphypium type. Among them, 1 case had renal vein type (8.3%), 9 cases (75%) had hepatic vein type and 2 cases (16.7%) had intrahepatic type without phrenic type. The diagnostic accuracy of color Doppler ultrasound in the diagnosis of vena cava tumor thrombus was 66.7% (8/12) and false negative 16.7% (2/12). The accuracy rate of CT was 83.3% (10/12) and false negative 16.7% (2/12). MRI accuracy of 100%. Three patients were lost to follow-up, 4 died of systemic failure and liver metastasis. The average survival time was 22 months. The remaining 5 patients were alive and survived for 6 to 38 months. No signs of tumor metastasis were found. Conclusion: MRI and color Doppler ultrasound are the best methods for diagnosis of renal cell carcinoma with venous thrombosis. For non-lymph node and distant metastasis, should take a positive surgical attitude, surgical approach depends on the level of tumor thrombosis.