摘要
目的 评估经腹部切口结合翻肝技术治疗肾肿瘤合并Ⅱ、Ⅲ级下腔静脉瘤栓的安全性和有效性.方法 2009年1月-2015年4月采用腹部切口治疗11例肾肿瘤合并Ⅱ、Ⅲ级下腔静脉瘤栓患者,年龄5～61岁,平均45.2岁;右侧8例,左侧3例.肿瘤直径9.2～15.8 cm,平均11.3 cm.采用Mayo Clinic的五级分类法进行瘤栓分级,其中Ⅱ级瘤栓6例,Ⅲ级瘤栓5例.术中采用背驮式肝移植技巧游离翻转肝脏,应用Pringle技术短暂阻断肝脏血流,取出下腔静脉内瘤栓并重建下腔静脉后,行肾肿瘤根治术.术后5例病理检查为透明细胞癌,予以辅助靶向治疗（舒尼替尼或索拉非尼）.结果 11例完整切除瘤栓和肿瘤,手术时间280～420 min,平均310 min;术中出血220～950 ml,平均410ml.围手术期无瘤栓栓塞和患者死亡.术后予以辅助靶向治疗,其副作用患者可以耐受.结论 经腹翻肝技术能够完全切除肾肿瘤合并Ⅱ、Ⅲ级下腔静脉瘤栓,避免体外循环的并发症.术后辅助靶向药物治疗,可能改善生存率.
[Objective] To evaluate the safety and efficacy of transabdominal approach and the use of liver mobilization technique for renal cell carcinoma with level U or Ⅲ inferior vena cava tumor embolus. [Methods] From Jan. 2009 to Apr. 2015, transabdominal radical nephrectomy was carried out in 11 patients with liver mobilization technique. The average age of the patients was 45.2 years （ranging 5-61 years）. The average diameter of tumor was 11.3 cm （ranging 9.2-15.8 cm）. Tumor was located in the right kidney in 8 cases, and in the left kidney in 3 cases. Mayo Clinic classification was applied to tumor embolus in the vena cava, 6 patients had level Ⅱ tumor embolus and 5 had level Ⅲ tumor embolus. The piggyback liver transplantation technique was used to expose the inferior vena cava. Pringle technique was tried to block hepatic blood flow. After removal of tumor embolus in the inferior vena cava and reconstruction of the inferior vena cava, a radical operation of renal tumor was performed. After surgery 5 cases were diagnosed as clear cell carcinoma, which was then treated with targeted therapy （Sunitinib or Sorafenib）. [Results] All the patients had complete tumor resection without intraoperative death or intraoperative embolism. The mean operative time was 310 rain （ranging 280-420 min）. The average blood loss was 410 ml （ranging 220-950 ml）.The patients tolerated the side effects of the molecular targeted agents. [Conclusions] The surgical techniques are safe and effective for resection of renal cell carcinoma with level Ⅱ or Ⅲ tumor embolus. These techniques can also prevent the complications of cardiopulmonary bypass. Postoperative adjuvant targeted drug therapy may raise the survival rate.
出处
《中国现代医学杂志》
CAS
北大核心
2015年第35期109-112,共4页
China Journal of Modern Medicine
关键词
翻肝技术
肾肿瘤
下腔静脉瘤栓
肾癌根治术
liver mobilization
renal cell carcinoma
inferior vena cava
tumor embolus
radicalnephrectomy
作者简介
通信作者：吴万瑞，E-mail：wuwanruil6@163．com；Tel：0731-83929243
