| 摘要: |
| 目的 探讨不同组织学来源的肿瘤侵犯肾上段下腔静脉的手术治疗策略。方法 收集海军军医大学（第二军医大学）长海医院2008年1月至2018年4月收治的32例肾癌下腔静脉癌栓、11例原发性下腔静脉平滑肌肉瘤、8例下腔静脉平滑肌瘤病患者的临床资料，其中男20例、女31例，年龄26～76（50.1±12.8）岁，患者均得到病理确诊，并接受开放或腹腔镜手术治疗。结果 50例患者完成手术切除，1例患者术中中止手术。32例肾癌下腔静脉癌栓患者中，单纯取栓30例，切除下腔静脉2例（1例右侧肾癌合并下腔静脉癌栓患者未行下腔静脉重建，1例左侧肾癌合并下腔静脉癌栓患者行下腔静脉重建）；11例原发性下腔静脉平滑肌肉瘤患者中，6例因肿瘤侵犯静脉壁而切除下腔静脉并行人工血管置换，4例切除肿瘤侵犯的部分下腔静脉壁并缝合重建，1例术中探查后无法切除肿瘤而中止手术；8例下腔静脉平滑肌瘤病患者均未行下腔静脉切除及重建。随访1～36个月（中位随访时间17个月），肾癌下腔静脉癌栓、原发性下腔静脉平滑肌肉瘤、下腔静脉平滑肌瘤病患者的总生存率分别为84.4%（27/32）、63.6%（7/11）和100.0%（8/8）。围手术期死亡4例，其中术中肾癌下腔静脉癌栓脱落并在围手术期死亡2例，肾癌下腔静脉癌栓及下腔静脉平滑肌肉瘤肝淤血导致术后弥散性血管内凝血死亡各1例；随访期间死亡5例，均死于肿瘤转移。结论 肾癌下腔静脉癌栓、原发性下腔静脉平滑肌肉瘤和下腔静脉平滑肌瘤病患者在人口学、侵犯血管情况、癌栓/瘤栓脱落风险、疾病预后方面存在明显差异，术前全面评估患者病情有助于更好地完成手术，但目前尚无在术前评估手术难度、避免癌栓/瘤栓脱落及避免术后严重并发症的有效方法。 |
| 关键词: 肾上段下腔静脉 肾癌下腔静脉癌栓 原发性下腔静脉平滑肌肉瘤 下腔静脉平滑肌瘤病 外科手术 |
| DOI：10.16781/j.0258-879x.2021.07.0717 |
| 投稿时间：2020-11-24修订日期：2021-02-09 |
| 基金项目: |
|
| Surgical management of tumors involving upper renal segment of inferior vena cava from different histological origins: similarities and differences |
| SONG Zi-jian1△,CHEN Rui1△,Lü Chen2,FENG Xiang1* |
(1. Department of Urology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Urology, Jiahui International Hospital, Shanghai 200030, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the surgical treatment strategies of tumors involving the upper renal segment of inferior vena cava from different histological origins. Methods The clinical data of 32 renal cell carcinoma patients with inferior vena cava tumor thrombus, 11 patients with primary leiomyosarcoma of inferior vena cava and 8 patients with inferior vena cava leiomyomatosis were collected from Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2008 to Apr. 2018. There were 20 males and 31 females, with an average age of (50.1±12.8) (ranged 26-76) years. All patients were confirmed by pathology and underwent open or laparoscopic surgery. Results Fifty patients received surgical resection and 1 surgery was terminated. Of the 32 patients with inferior vena cava tumor thrombus, 30 received thrombectomy and 2 received resection of the inferior vena cava (1 case of right renal cell carcinoma with tumor thrombus did not receive reconstruction of the inferior vena cava, and 1 case of the left renal cell carcinoma with tumor thrombus underwent reconstruction of the inferior vena cava). Of the 11 patients with primary leiomyosarcoma of inferior vena cava, 6 received complete resection of the inferior vena cava and the inferior vena cava was replaced by artificial blood vessel, 4 received partial resection of the invaded inferior vena cava and the inferior vena cava was sutured for reconstruction, and 1 surgery was terminated after intraoperative exploration. Eight patients with inferior vena cava leiomyomatosis did not undergo resection or reconstruction of the inferior vena cava. At a median follow-up of 17 months (ranged 1-36 months), the survival rates of the 3 groups were 84.4% (27/32), 63.6% (7/11) and 100.0% (8/8), respectively. Four cases died during the perioperative period, including 2 cases of renal cell carcinoma with thrombus shedding during operation, 1 case of renal cell carcinoma with inferior vena cava tumor thrombus and 1 case of inferior vena cava leiomyosarcoma resulted in hepatic congestion and postoperative disseminated intravascular coagulation. Five cases died of tumor metastasis during follow up. Conclusion There were significant differences in demography, vascular invasion, shedding risk of cancer/tumor thrombus and prognosis among patients with renal cell carcinoma with inferior vena cava tumor thrombus, primary leiomyosarcoma of inferior vena cava and inferior vena cava leiomyomatosis. Preoperative comprehensive evaluation of the patient's condition can be helpful, but there is no effective method to assess the difficulties of surgery preoperatively or to avoid the shedding of cancer/tumor thrombus and severe postoperative complications. |
| Key words: upper renal segment of inferior vena cava renal cell carcinoma with inferior vena cava tumor thrombus inferior vena cava leiomyomatosis inferior vena cava leiomyosarcoma operative surgical procedures |
