摘要
目的探讨经皮球囊导管阻断技术在下腔静脉瘤栓切除术中的应用价值。方法经CT、MRI及彩色多普勒超声等检查确诊为肾或肾上腺肿瘤合并肝后型或肝下型下腔静脉瘤栓患者12例。男7例，女5例。年龄20～76岁，平均51岁。右侧肿瘤11例，左侧1例。肾肿瘤11例，肾上腺肿瘤1例。12例均于术前经皮穿刺右侧颈内静脉，于瘤栓近心端下腔静脉内预置一球囊导管，术中经导管充盈球囊阻断下腔静脉后，再行下腔静脉瘤栓切除术。结果12例肿瘤合并下腔静脉瘤栓的根治性切除术全部完成。手术时间210～670min，平均324min。术中出血量600～7960ml，平均2563ml。无手术或围手术期死亡。术后患者恢复良好，肝肾功能正常，无并发症发生。术后平均12（9～15）d出院。术后病理报告：肾细胞癌9例，转移性肝细胞癌1例，良性血管平滑肌脂肪瘤1例，肾上腺平滑肌肉瘤1例。肾癌术后TNM分期：T3bN0M08例，L3bNxM11例。术后平均随访（21±10）个月，中位随访时间24个月。4例分别于术后6、9、15、22个月死于肺转移、肝转移及肝癌复发，其余8例术后已存活6～35个月，平均26个月。9例肾癌患者术后1、3年肿瘤特异生存率分别为78％和67％。结论经皮球囊导管阻断技术在低位肝后型或肝下型下腔静脉瘤栓的根治性切除术中是一种安全、简便、有效的方法，具有重要的临床应用价值。
Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombeetomy in renal or adrenal neoplasm extending into the inferior vena eava（IVC）. Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MRI, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years （range, 20 to 76 years）. Of these patients, 11 had renal neoplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus （level 2a） extension and 1 with extension into the subhepatic vena cava （level 1）. On the operation day, all patients had a percutaneous preset of the balloon catheter into the IVC, at the position between hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postoperative hospital stay was 12 d （range, 9 to 15 d）. Pathological investigation revealed clear cell carcinoma
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2009年第5期313-316,共4页
Chinese Journal of Urology
作者简介
通信作者：肖序仁，Email：xrxiao@msn．com
