| 摘要: |
| 目的 探讨累及下腔静脉的腹膜后肿瘤患者术中联合行下腔静脉部分整段切除免重建术式的手术技巧及安全性。方法 回顾性分析北京大学国际医院腹膜后肿瘤外科2015年3月至2020年2月收治的累及下腔静脉的27例腹膜后肿瘤患者资料。27例患者术中均联合行下腔静脉部分整段切除免重建术。将下腔静脉分为4段，Ⅰ段为髂总静脉分叉至肾静脉入口下方2 cm，Ⅱ段为肾静脉下方2 cm至肾静脉上方2 cm，Ⅲ段为肾静脉上方2 cm至膈肌，Ⅳ段为膈上段。根据下腔静脉分段及侧支循环情况制订手术方案。观察术后下腔静脉切除相关并发症的发生情况，记录术前、术后肾功能指标并进行比较。结果 所有患者均顺利实施手术，无手术相关死亡，其中R0切除22例、R1切除5例，下腔静脉切除部位包括Ⅰ段11例、Ⅱ段5例、Ⅱ+Ⅲ段6例、Ⅲ段5例。10例术中联合右肾切除，4例联合肝转移瘤切除，3例联合右半结肠切除，2例联合小肠部分切除，2例联合右侧髂动脉人工血管重建。联合右肾切除患者的术前血肌酐水平为（58.1±14.5）μmol/L，术后2周血肌酐水平为（63.1±16.2）μmol/L，差异无统计学意义（P>0.05）。术后发生中至大量腹水（术后1周腹水平均引流量>400 mL/d）6例、下肢水肿5例，均在术后2周左右逐渐恢复正常；术后肾功能不全患者4例，其中2例行短暂血液透析替代治疗后恢复。结论 腹膜后肿瘤侵犯不同部位下腔静脉，在侧支循环已充分建立或可预见重建的情况下，术中联合实施下腔静脉部分整段切除免重建术式是安全、可靠的，术前精准评估可有效指导手术方案的制订并控制术后并发症风险。 |
| 关键词: 腹膜后肿瘤 下腔静脉 整段切除 肾功能不全 |
| DOI：10.16781/j.0258-879x.2021.06.0693 |
| 投稿时间：2020-11-12修订日期：2021-03-21 |
| 基金项目:国家卫生健康委医药卫生科技发展研究中心微创手术临床应用规范研究项目（WA2020RW29）. |
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| Safety of segment resection of inferior vena cava without reconstruction in patients with retroperitoneal tumors |
| TANG Mao-sheng,MIAO Cheng-li,CHEN Xiao-bing,LIU Shi-bo,ZOU Bo-yuan,LUO Cheng-hua* |
(Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing 102206, China
*Corresponding author) |
| Abstract: |
| Objective To explore the surgical techniques and safety of combined segment resection of inferior vena cava without reconstruction for retroperitoneal tumors. Methods The data of 27 patients with retroperitoneal tumors involving inferior vena cava admitted to the Department of Retroperitoneal Tumor Surgery of Peking University International Hospital from Mar. 2015 to Feb. 2020 were retrospectively analyzed. All the patients underwent combined segment resection of the inferior vena cava without reconstruction. The inferior vena cava was divided into 4 segments: segmentⅠ (from the bifurcation of the common iliac vein to 2 cm below the entrance of the renal vein), segmentⅡ (from 2 cm below the renal vein to 2 cm above the renal vein), segmentⅢ (from 2 cm above the renal vein to below the diaphragm) and segmentⅣ (supradiaphragmatic segment). According to the inferior vena cava segmentation and collateral circulation, the surgical plans were formulated, the related postoperative complications of the inferior vena cava resection were observed, and the preoperative and postoperative renal function indicators were recorded and compared. Results The surgery was successfully completed in all the 27 patients without operative death, with R0 resection in 22 cases and R1 resection in 5 cases, including 11 cases of segmentⅠ inferior vena cava resection, 5 cases of segmentⅡ, 6 cases of segment Ⅱ+Ⅲ, and 5 cases of segmentⅢ. Ten cases were combined with right nephrectomy, 4 cases with hepatometastasis resection, 3 cases with right hemicolectomy, 2 cases with small intestine partial resection, and 2 cases with right iliac artery artificial vessel reconstruction. The creatinine level of the patients with right nephrectomy was (58.1±14.5) μmol/L before operation, and was (63.1±16.2) μmol/L 2 weeks after operation, showing no significant difference (P>0.05). Six cases had moderate or large amount of ascites (the average drainage volume of ascites was more than 400 mL/d one week after operation), and 5 cases had lower extremity edema which gradually returned to normal about 2 weeks after operation; 4 cases had renal insufficiency after operation, and 2 of them recovered after short-term hemodialysis replacement therapy. Conclusion Retroperitoneal tumors can invade different parts of the inferior vena cava. Segment resection without reconstruction is safe and reliable when collateral circulation has been fully established or reconstruction is predictable. Accurate preoperative assessment can effectively guide the surgical approach and control the risk of postoperative complications. |
| Key words: retroperitoneal neoplasms inferior vena cava segmental resection renal insufficiency |
