肾静脉上结扎大鼠下腔静脉的心脏血流动力学改变和川芎嗪对其的影响

目的 探讨肾静脉平面以上结扎大鼠下腔静脉及应用川芎嗪后的心脏血流动力学改变。方法 在肾静脉平面以上结扎大鼠下腔静脉及川芎嗪治疗，术后1、6、24、48h检测心率、射血分数、心输出量、每搏输出量、鼠尾动脉压等心脏血流动力学指标。结果 单纯结扎大鼠下腔静脉后心输出量减少、血压下降，但至术后48h可完全代偿，动物全部存活。结扎下腔静脉并川芎嗪治疗术后心输出量减少、血压下降，但术后24h即可完全代偿，动物全部存活。结论 肾静脉平面以上结扎大鼠下腔静脉可使回心血量急骤减少而影响心功能，但术后48h即可完全代偿。若结扎下腔静脉同时加用川芎嗪治疗，可明显改善心功能状况。建议当腹膜后肿瘤侵及肾静脉平面以上的下腔静脉时，切除肿瘤及其累及下腔静脉段后，可直接结扎下腔静脉，同时加用川芎嗪治疗，无需附加健康右肾切除。术后早期应注意经上肢浅静脉补充液体以增加回心血量。     

肾癌伴肾静脉或下腔静脉癌栓11例分析

通过对11例肾癌伴肾静脉或下腔静脉癌栓患者的临床分析,认为肾癌伴静脉癌栓者90.9％有包块或疼痛;术前诊断十分重要,CT的诊断率(100％)显著高于B超(42.9％),下腔静脉造影可作为CT的辅助检查方法;手术仍是治疗肾静脉或下腔静脉癌栓的唯一有效方法。     

受体存在双重下腔静脉的解剖变异的肝移植:术中应注意左肾静脉的结扎

下腔静脉（inferior vena cava,IVC）的解剖学变异很罕见,通常由3对胚胎静脉的发育异常引起。双重IVC是IVC畸形中最常见的解剖变异之一（流行率为0.2%~3.0%）。双IVC位于腹主动脉的两侧。在组合双重IVC和大型脾肾分流术（spleno-renal shunt,SRS）的情况下,解剖骨骼化左肾静脉（left renal vein,LRV）应从它与IVC连接处的上部开始。     

肾血管平滑肌脂肪瘤并肾静脉及下腔静脉瘤栓一例报告

患者,男, 48岁。因右肾血管平滑肌脂肪瘤(RH)并肾静脉及下腔静脉瘤栓术后 1个月入院。CT发现右肾占位约 10. 0cm×8. 0cm×8. 0cm,无血尿、无腰痛。在外院行右肾切除术,术中见右肾静脉及下腔静脉内瘤栓形成,未处理下腔静脉内瘤栓。右肾及肾静脉内瘤栓病理诊断均为RH。术后彩超及MRI均提示右肾静脉平面至第二肝门平面下腔静脉内占位性病变,腔静脉造影提示上述病变范围有充盈缺损。查体未见异常,肝肾功能正常。于 2004年 5月 20日在全麻下行下腔静脉探查术。术中见下腔静脉与周围组织粘连严重,游离并于右肾静脉残迹以下及第二肝门平面…     

肾血管平滑肌脂肪瘤合并肾静脉和下腔静脉瘤栓一例报告

肾血管平滑肌脂肪瘤合并肾静脉和下腔静脉瘤栓临床罕见 ,我院收治 1例 ,现报告如下。病例报告　患者 ,女 ,63岁。已婚。因右腰部隐痛 1个月于 2 0 0 0年 4月入院。无发热 ,食欲正常 ,无消瘦 ,无肉眼血尿。查体 :腹部平软 ,无压痛 ,未扪及包块 ,双肾区无叩痛。 7年前Ｂ超发现右肾囊肿 ,未治。ＫＵＢ和ＩＶＵ检查 :右肾上极占位性病变 ,双肾功能良好。Ｂ超示右肾上极实性占位性病变 6.8ｃｍ× 5 .8ｃｍ ,下极囊肿分别为 4.1ｃｍ× 3 .0ｃｍ及 1.9ｃｍ× 1.8ｃｍ ,肝下方下腔静脉瘤栓 4.2ｃｍ× 1.4ｃｍ。ＭＲＩ检查 :右肾占位性病变 ,右肾静脉…     

门静脉高压症大鼠阻断门静脉和下腔静脉后肾脏损伤的研究

目的探讨门静脉高压症大鼠阻断门静脉和下腔静脉1h后肾脏损伤的情况。方法Wistar大鼠随机分为对照组、门脉高压症对照组和实验组。实验组先建立可复性门静脉高压症大鼠模型,3周后按阻断下腔静脉和肝门1h后不同的再灌注时间0h、6h、12h、24h、48h、72h和7d分为7组。于相应时间点查血清ALT、BIL、BUN、Cr水平,肾脏和肝脏组织光镜以及肾脏组织透射电镜检查。结果实验组大鼠血BUN、Cr再灌注后6h开始升高,12~24h达高峰,此后渐下降,72h已基本恢复正常。肾脏损害主要以近曲肾小管上皮细胞为主,12h、24h损伤达到高峰,可见核固缩、核碎裂,但基底膜保留完好。48h开始出现修复现象。7d后明显修复。结论门静脉高压症大鼠阻断门静脉和下腔静脉后,肾小管上皮细胞有明显损伤,但是损伤是可逆的。     

下腔静脉与肝静脉的外科应用解剖

在３２例成人尸体上进行腔静脉与肝静脉的应用解剖学的研究，观测了右肾上腺静脉、左膈下静脉、主肝静脉的长度、横径、注入角度和部位及主肝静脉的汇合类型和下腔静脉各段长度。结果表明，术中阻断肝上膈下下腔静脉，有８４．４％的人可经腹部切口完成，另１５．６％者可能需开胸在心包内阻断下腔静脉，下腔静脉下阻断，有８７．５％可在网膜孔后分离阻断，１２．５％需行下腔静脉肝后段分离阻断。在游离肝右叶时，需注意可能出现的     

不同肝上下腔静脉重建方法对大鼠肝移植术后血流动力学的影响

目的 本研究旨在探讨肝上下腔静脉的不同重建方法对大鼠肝移植术后血流动力学的影响.方法 根据Kamada二袖套法、改良内覆静脉支架法和Harihara三袖套法3种不同的肝上下腔静脉重建方法将SD大鼠分为3组,每组先取12对记录手术成功情况、手术操作时间、术后1个月受体存活情况、肝脏弹性模量值、静脉血栓发生情况等.另以10只相近体质量大鼠作为对照组,测定其肝脏弹性模量值.利用激光散斑灌注成像（LS PI）监测3组移植组受体移植肝复流后和对照组肝脏的微循环.术后24,72 h和1个月,3组移植组各时间点再另取6只存活受体进行血流动力学参数检测.结果 二袖套组、支架组和三袖套组手术成功比例分别为12/12,11/12和11/12.术后1个月,二袖套组、支架组和三袖套组分别有11（11/12）,9（9/11）和9（9/11）只受体存活,分别有0,7,4例发生静脉血栓;二袖套组发生静脉血栓比例低于支架组和三袖套组（P=0.000和0.026）.二袖套组、支架组和三袖套组术后1个月和对照组肝弹性模量值分别为7.0±0.4,15.3 ±1.6,7.5 ±0.7和5.6 ±0.7,各移植组均高于对照组（F=209.70,P ＜0.05）.移植肝复流后LSPI流量值逐步增加,但复流3,10,20 min后,各移植组间LSPI流量值差异无统计意义（F=1.96,3.81和1.65,P均＞0.05）;复流20 min时,各移植组LSPI流量值仍低于对照组（F =237.65,154.02和50.95,P均＜0.05）.将对照组大鼠血流动力学结果作为正常参考值,各移植组术后肝下下腔静脉（IHVC）和门静脉（PV）血流量、压力均逐渐升高.术后24,72 h和1个月,3组移植组大鼠IHVC和PV血流量均低于对照组,支架组最低（F=71.4和54.3,79.8和54.3,84.5和29.6,P均＜0.05）;3组移植组大鼠IHVC压力均高于对照组,支架组最高（F=73.5、159.8和110.1,P＜0.05）.术后24,72 h,二袖套组和三袖套组PV压力均低于对照组,而支架组高于对照组（F =126.6和193.5,P均＜0.05）.术后1?     

自体静脉碎片种植Dacron替代犬部分下腔静脉的研究

实验种植组１３条犬取自体颈静脉碎片，用肝素盐水配成悬液，经Ｄａｃｒｏｎ（直径６￣８ｍｍ，长４ｃｍ）腔内用注射器反复抽吸，使碎片及细胞镶嵌种植于其壁内，再以自体静脉血预凝后植入下腔静脉；对照组８条犬所用Ｄａｃｒｏｎ仅全血预凝。结果发现：种植组通畅率６１．５％，对照组２５．０％；种植组移植物腔面术后二周形成完整内皮细胞层、腔面组织６－Ｋ－ＰＧＦ１α释放量明显高于对照组；表明自体静脉碎片种植，可促使Ｄａ     

Renal pelvis squamous cell carcinoma with inferior vena cava infiltration: Case report and review of the literature

INTRODUCTION

Renal squamous cell carcinoma (RSCC) is a rare tumor that is usually diagnosed late as a locally advanced malignancy with adjacent structure involvement. Radical surgical resection with negative margins is the mainstay of treatment, as it is correlated with improved survival, while other modalities of treatment have been shown to have limited efficacy.

PRESENTATION OF CASE

We report a case of a 56 year old gentleman with right RSCC with tumor encasing the inferior vena cava (IVC), treated successfully with surgical resection.

DISCUSSION

The surgical management of vascular involvement of similar tumors has not been discussed in-depth in the literature. Surgical resection of the IVC without reconstruction can be done successfully in the circumstance of good collateral circulation; otherwise IVC resection with reconstruction will be necessary.

CONCLUSION

Radical resection with clear margins of RSCC tumors with vascular involvement is feasible in selected circumstances.     

Renal transplantation in children with thrombosis of the inferior vena cava requires careful assessment and planning

Children with end-stage renal disease and inferior vena cava (IVC) thrombosis are rare, and their condition is complex and high risk for renal transplantation. Detailed imaging studies of the recipient’s abdominal vasculature should be carried out prior to transplantation, followed by careful pre-operative joint planning by the pediatric transplant surgeon and nephrologist. Critical decisions need to be made as to whether a deceased child’s kidney or an adult-sized kidney is to be used, and if the latter, whether it should be from a deceased or living donor. In addition, the contemplated site of the donor’s renal vein anastomosis needs to be determined with a consideration of the possible consequences of the various choices. Sixteen cases of renal transplantation in children with pre-existing IVC thrombosis are reviewed, including the three reported by Shenoy et al. in this journal. With a full understanding of the difficulties noted, renal transplantation in a small child with IVC thrombosis can be successful. However, it requires thorough recipient assessment, coupled with a careful and thoughtful examination of options, to determine the best possible approach to the transplantation.     

Resection and reconstruction of the inferior vena cava for neoplasms

AIM: To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC). METHODS: The approach to caval resection depends on the extent and location of tumor involvement. The supraand infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins. RESULTS: The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography. CONCLUSION: There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.     

血管腔内技术治疗下腔静脉综合征

目的 探讨血管腔内技术治疗下腔静脉综合征的疗效。方法 2002年6月～2004年11月对17例下腔静脉综合征进行下腔静脉腔内扩张、腔内支架植入术,术后常规抗凝治疗。结果 下腔静脉压力梯度从治疗前（16.8±4.3）mmHg下降到治疗后（2.6±0.6）mm Hg（t=13.280,P=0.001）。IVCS症状评分从治疗前（4.4±1.6）分下降到治疗后（2.1±1.7）分（t=6.880,P=0.010）。下肢肿胀、阴囊或外阴浮肿、腹水和全身浮肿于术后1～4 d后减轻。结论 血管腔内技术治疗下腔静脉综合征疗效可靠。     

Evaluation of the inferior vena cava in potential pediatric renal transplant recipients

Vascular anomalies due to occlusion or thrombosis of the inferior vena cava (IVC) may be hazardous to renal transplantation, and preoperative vascular evaluation is important for safe and successful surgery. The purpose of this study was to assess the utility and accuracy of two-dimensional time-of-flight (2D-TOF) magnetic resonance venography (MRV) as an alternative to conventional angiography for evaluating the IVC and iliac vein in potential pediatric renal transplant recipients. Four children with chronic renal failure were evaluated with 2D-TOF MRV by superior presaturation pulse and target maximum intensity projection. The whole MRV examination and filming required less than 30 min. All four patients had a normal IVC and iliac vein. Two of the patients underwent renal transplantation, and the MRV findings were in total agreement with the final anatomy revealed intraoperatively. MRV is accurate for evaluating the condition of the IVC and iliac vein. It is a reliable, noninvasive and rapid technique that can be considered as an alternative to invasive angiography for evaluation of children scheduled for transplantation. We recommend the use of this noninvasive procedure to ascertain the patency of the IVC in all infants and children with a history of indwelling catheters in the IVC or those with a propensity to thrombosis, i.e., all recipients with nephrotic syndrome. The insertion of catheters in the femoral vein in children who may become candidates for renal transplantation should be discouraged.     

Successful renal transplantation in children in the presence of thrombosis of the inferior vena cava

Thrombosis of the inferior vena cava (IVC) has previously been considered to be a contraindication to renal transplantation in children because of the technical difficulties associated with surgery and the increased risk of graft thrombosis. We report three children with previous IVC thrombosis who underwent renal transplantation at our institution over the last 5 years. The pretransplant imaging of these patients included direct venography or magnetic resonance venography to evaluate venous outflow. Two children (19 kg and 36 kg) received deceased donor renal allografts with no surgical complications or delayed graft function. At the latest follow-up 3.0 and 4.6 years posttransplantation, respectively, they were well, with estimated glomerular filtration rates of 52 and 64 ml/min per 1.73 m(2), respectively. The third child underwent a live-related-donor renal transplant at the age of 4.9 years (weight 13.5 kg). There was primary graft nonfunction. Renal vein thrombosis was noted on postoperative day 12, with subsequent graft loss. Children with previous IVC thrombosis can be successfully transplanted with adult-sized kidneys provided detailed evaluation of the venous drainage has been performed. There is substantial risk of graft thrombosis, and detailed counselling regarding the specific risks of the procedure is essential.     

下腔静脉内平滑肌瘤病诊治分析

目的 总结下腔静脉内平滑肌瘤病的诊治经验.方法 回顾性分析1998年3月至2007年4月收治的8例下腔静脉内平滑肌瘤病患者的临床资料,并随访观察其疗效.结果 8例患者中4例术前经下腔静脉造影同时取活检术前诊断为下腔静脉内平滑肌瘤病.8例患者中有1例拒绝手术治疗,14个月后猝死.接受手术治疗的7例患者术后病理示IVL,其中除1例死于术中大出血,1例术后2年复发外,其余5例无严重并发症,术后随访7～65个月,平均随访29个月,已恢复正常生活.结论 下腔静脉内平滑肌瘤病多源于子宫平滑肌瘤,是一种雌激素依赖性肿瘤.下腔静脉造影的同时取活组织检查是术前诊断下腔静脉内平滑肌瘤病的有效方法.手术切除肿瘤是惟一有效的治疗方法,同时应进行抗雌激素治疗,近期疗效满意.     

紧贴下腔静脉肝血管瘤的手术治疗

目的探讨紧贴下腔静脉（inferior vena cava,IVC）的肝血管瘤的手术治疗。方法回顾性分析2003年1月至2005年9月手术切除的30例紧贴IVC的肝血管瘤的临床资料,利用第三肝门解剖法、肝静脉结扎阻断法、半肝血流阻断法3种方法,切除紧贴IVC的肿瘤。结果30例肝血管瘤均安全切除,IVC修补5例,术中出血量100～5000ml。术后无明显并发症发生。随访至今,1例血管瘤复发,其余均良好。结论把肿瘤的流入、流出道在肝外预先处理,可以减少手术的风险。术中注意肿瘤的显露,力争肿瘤的完整切除,避免流出道梗阻,肝脏创面渗血不止等紧急情况下压纱布也是一种有效的选择。     

肾癌并发下腔静脉癌栓的诊断与治疗

目的：提高对肾癌并发下腔静脉癌栓的诊断及治疗经验。方法：分析8例肾癌并发下腔静脉癌栓的诊断方法及治疗措施。结果：术前已明确诊断6例,8例均经手术治疗,1例术中死亡,余7例手术成功。结论：手术切除肾癌并取出癌栓是目前有望治愈的方法之一,手术方式的选择取决于癌栓的大小及部位。手术风险大、难度大,必须警惕癌栓的脱落。