肾癌合并肾静脉或下腔静脉癌栓的诊断和治疗体会

目的总结肾癌合并肾静脉或下腔静脉癌栓的诊断、治疗体会,评价其预后和治疗价值。方法对1994年7月—2006年7月接受诊治的15例肾癌合并肾静脉或下腔静脉癌栓患者的诊断、治疗方法和预后进行回顾性分析。结果14例患者术前CT或MRI检查明确诊断合并肾静脉或下腔静脉癌栓。单纯左肾静脉癌栓2例,下腔静脉癌栓Ⅰ型(肾旁型)9例,Ⅱ型(肝下型)3例,Ⅲ型(肝内型)1例。12例患者接受手术治疗.其中11例完成肾肿瘤切除、静脉癌栓取除和淋巴清扫,1例左肾肿瘤因与周围粘连仅作姑息切除。3例未手术患者因癌症死亡,中位存活时间为7个月。12例手术患者中失访3例,其余9例随访4个月～6年,无瘤生存5年以上者3例.1～3年3例,因癌症转移1年内死亡3例。结论CT、MRI检查是目前无创诊断肾癌合并肾静脉或下腔静脉癌栓的最佳方法。术前肾动脉栓塞可以非常有效地减少术中出血,方便手术完成。无转移患者行根治手术加癌栓切除能获得相对满意的治疗效果。

Diagnosis and treatment of renal cell carcinoma with tumor thrombi of renal vein and inferior vena cava

Objective To report our experience on diagnosis and treatment of renal cell carcinoma (RCC) complicated with tumor thrombi of renal vein or inferior vena cava,so as to assess the diagnosis,treatment and prognosis of the condition.Methods The clinical data of 15 patients with RCC complicated with tumor thrombi of renal vein or inferior vena cava,who were treated during July 1994 to July 2006,were retrospectively ana- lyzed.Results Tumor thrombi of the renal vein or inferior vena cava were detected in 14 patients by CT scan and MRI before operation.Two patients had tumor thrombi within the renal vein,9 with intrahepatic vena cava, 3 with intrahepatic subphrenic vena cava,and 1 with supraphrenic vena cava.Eleven of 12 patients received radi- cal nephrectomy and thrombectomy;only 1 received radical nephreetomy.Three patients who refused operation died of cancer,with a mean survival time of 7 months.Nine patients had been followed up for 4-72 months after surgery.Six patients survived disease-free for more than 1 year.No patients with lymph node or lung involve- ment survived longer than 12 months after surgery,including 3 for more than 5 years.Three patients were not followed up.Conclusion CT and MRI are the best choice for non-traumatic diagnosis of RCC complicated with renal vein or inferior vena cava tumor thrombi.Preoperative embolization of renal arteries can effectively reduce blood loss during operation.Radical nephrectomy plus thrombectomy can achieve long-term survival in patients with localized RCC and renal vein or inferior vena cava thrombi.