腹腔镜下微创手术治疗肾癌合并高位肝后下腔静脉癌栓

目的探讨腹腔镜下微创手术治疗肾癌合并高位肝后下腔静脉癌栓的临床经验和文献分析。 方法女性患者，61岁，临床诊断：右肾癌合并高位肝后下腔静脉癌栓。术前全面评估手术风险，组织多学科会诊为患者制定详尽的围手术期治疗与护理方案，拟行腹腔镜下右侧肾癌根治性切除+高位肝后下腔静脉癌栓取出+腹膜后淋巴结清扫术。术后医护密切配合严密观察患者病情变化，进行围手术期观察处理与护理。 结果手术顺利完成，手术时间390 min，无中转开放手术。术中完全游离右侧和左侧肾静脉、肝后下腔静脉直达第二肝门水平远端，近右肾静脉处下腔静脉内侧壁剪开静脉壁，癌栓下部小灶性侵犯静脉壁，切除部分腔静脉壁完整取出癌栓，恢复左侧肾静脉、腔静脉血流回流无障碍。术后病理提示符合透明细胞癌，癌组织侵犯肾窦脂肪，腹膜后淋巴结（-）。术后随访6个月未见肿瘤复发。 结论腹腔镜下微创手术治疗肾癌合并高位肝后下腔静脉癌栓安全可行，多学科协助模式为疑难复杂病例提供了一种新的选择，值得临床进一步推广。

Laparoscopic surgery for renal cell carcinoma with high post-hepatic inferior vena cava tumor thrombus

ObjectiveTo explore experiences and literatures of laparoscopic minimally invasive surgery for renal cell carcinoma with high post-hepatic inferior vena cava tumor thrombus. MethodsFemale patient, 61 years old, clinical diagnosis: right kidney cancer with high post-hepatic inferior vena cava tumor thrombus. Comprehensive evaluation of surgical risk before surgery, organization of multidisciplinary consultation for patients were performed detailed perioperative treatment and care plan, laparoscopic radical nephrectomy for right kidney cancer + high post-hepatic inferior vena cava tumor thrombectomy + retroperitoneal lymph node dissection. The operation was successfully completed. Postoperative care and close coordination were closely observed for the patient's condition changes. ResultsThe operation was successfully completed, operation time was 390 minutes, and there was no conversion to open surgery. During the operation, the right and left renal veins and the posterior inferior vena cava were directly connected to the distal end of the second hepatic hilum. The inferior vena cava in the proximal right renal vein was cut the vein wall, and the lower part of the tumor thrombus invaded the vein wall. Excision of part of the vena cava wall to completely remove the tumor thrombus, restore the left renal vein, vena cava blood flow back to the barrier. Postoperative pathological findings were consistent with clear cell carcinoma, cancer tissue invasion of renal sinus fat, and retroperitoneal lymph nodes(-). No tumor recurrence was seen after 6 months of follow-up. ConclusionLaparoscopic minimally invasive surgery for the treatment of renal cell carcinoma with high post-hepatic inferior vena cava tumor thrombus is safe and feasible. The multidisciplinary assisted model provides a new option for difficult and complicated cases, which is worthy of further clinical promotion.