球囊辅助阻断下腔静脉治疗肾肿瘤合并下腔静脉瘤栓

目的探讨球囊辅助阻断下腔静脉治疗肾肿瘤伴下腔静脉瘤栓的疗效。方法总结2005年5月至2006年5月收治的肾肿瘤伴下腔静脉瘤栓患者9例,其中男性6例,女性3例;年龄20—76岁,平均年龄53岁;右肾肿瘤8例,左肾肿瘤1例。对患者在球囊辅助下阻断下腔静脉,行患肾切除下腔静脉取栓。结果手术均单纯经腹切口完成,取出下腔静脉内瘤栓平均长度5．0cm（3．0～6．7cm）,术中血压、心率平稳,术后无并发症,随访6～18个月,死亡1例,存活8例。结论应用球囊辅助阻断下腔静脉,极大地方便了Ⅱ型、Ⅲ型瘤栓手术的操作,降低了手术创伤和风险,具有临床推广价值。     

腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术

目的 探讨腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术的可行性. 方法 右肾占位病变患者2例.增强CT显示1例肿物部分延伸至肾静脉及腔静脉内,1例右肾静脉内可见充盈缺损并突入腔静脉内.均在全麻下行经后腹腔镜下根治性右肾切除及肾静脉、腔静脉取栓术.术中放置4个穿刺套管针,切断肾动脉后游离腔静脉及肾静脉,腔镜血管阻断钳部分阻断腔静脉,切开腔静脉取出瘤栓,缝合腔静脉,完整切除肾脏及瘤栓. 结果 2例患者的腔静脉瘤栓长度分别为0.3和1.0 cm,均安全取出,术后恢复良好,5 d出院.病理诊断分别为上皮样肾血管平滑肌脂肪瘤和肾透明细胞癌1～2级.术后随访5个月未见肿瘤复发和转移. 结论 对选择性肾肿瘤并肾静脉及腔静脉瘤栓患者行腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术安全可行.     

腔静脉滤器辅助治疗肾血管平滑肌脂肪瘤并下腔静脉瘤栓（附2例报告并文献复习）

目的：良性的肾血管平滑肌脂肪瘤（angiomyolipoma．AML）很少呈现侵犯肾静脉,下腔静脉和心房。报道2例良性肾脏AML并下腔静脉瘤栓,探讨AML的恶性特征及治疗方法。方法：两侧患者均行介入下腔静脉滤器置入,并右肾根治性切除和腔静脉瘤栓取出术。结果：术后病理证实为血管平滑肌脂肪瘤。患者术后无不适症状,术后复诊未见肿瘤复发转移。结论：良性的肾血管平滑肌脂肪瘤可侵犯肾静脉及下腔静脉,呈现恶性肿瘤特征。鉴于肿瘤栓子进入心脏和肺的风险,应及时手术处理肾AML及下腔静脉栓子。     

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并静脉瘤栓1例报告与文献复习

汇报1例肾血管平滑肌脂肪瘤（renal angiomyolipoma,RAML）伴静脉瘤栓年轻女性患者的诊断与治疗,并复习文献,重点探讨预防瘤栓脱落方法及保留肾单位手术的可行性。该患者尝试行机器人辅助腹腔镜下静脉取栓术+肾部分切除术,因取净瘤栓困难,血流阻断时间过长改行肾切除术。病理证实为RAML伴静脉瘤栓。RAML合并静脉瘤栓具有潜在的瘤栓脱落、肺动脉栓塞等高死亡风险。术前腔静脉滤器置入联合肾动脉栓塞可以尽可能地降低瘤栓脱落风险。保留肾单位治疗的手术方式具有挑战性,但是已经有成功案例,值得尝试。     

恶性倾向肾巨大血管平滑肌脂肪瘤伴下腔静脉瘤栓1例报告并文献复习

目的：报告1例巨大肾血管平滑肌脂肪瘤合并腔静脉瘤栓病例。通过文献复习,探讨恶性倾向肾血管平滑肌脂肪瘤（renalangiomyolipoma,AML）的诊断与治疗。方法：报道和分析1例巨大AML伴下腔静脉瘤栓的病例资料,并通过查阅文献,分析和探讨具有恶性倾向的AML的临床表现、临床与病理学特性、诊断与鉴别诊断及外科治疗。结果：患者以双下肢肿胀就诊并行CT及MRI检查,提示AML伴肝后下腔静脉瘤栓（MayoIII）形成。行根治性肾切除和腔静脉瘤栓取出术,术后恢复良好。组织病理学证实为AML及静脉内肿瘤栓子。结论：散发的或结节性硬化症（tuberous sclerosis complex,TSC）相关的AML通常为间叶组织来源的良性肿瘤。罕见的,当瘤体侵犯肾静脉或下腔静脉并形成瘤栓时具有侵袭性。这种恶性潜能被认为是上皮样血管平滑肌脂肪瘤（EAMLs）的生物学特性,手术切除肿瘤并取出瘤栓是可能治疗这类AML的惟一有效方法。 我们的研究强调了严密的术前评估、精细的术中操作、审慎的组织病理学检查及密切的术后随访,以求获得更好的预后。     

经皮球囊导管阻断技术在下腔静脉瘤栓切除术中的应用

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210～670 min,平均324 min.术中出血量600～7960 ml,平均2563 ml.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:T3b N0M08例,T3bNxM11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.     

改良机器人辅助腹腔镜下右肾癌根治术联合下腔静脉Ⅰ级癌栓切除术一例报道（英文）

下腔静脉癌栓切除术是泌尿系统最复杂和最具挑战性的手术之一。本文报道1例改良的机器人辅助腹腔镜下右肾癌根治术联合下腔静脉I级癌栓切除术。相比常规下腔静脉癌栓切除术,改良的机器人辅助腹腔镜下腔静脉癌栓切除术不需要完全分离下腔静脉,无需结扎腰静脉、肾上腺静脉,不用阻断下腔静脉、左肾静脉,也不需要切开下腔静脉和重建下腔静脉。本例手术先完全分离右肾,然后向侧面抬起右肾,使下腔静脉内的瘤栓降至肾静脉入下腔静脉处,然后用机械臂将瘤栓完全推进右肾静脉内,在不阻断下腔静脉的情况下完整切除瘤栓。此改良手术成功完成,无任何并发症,未进行输血。患者随访4年后无任何复发迹象。这表明此改良手术简单、安全、可行、值得推广,尤其适用于初学者。     

腔静脉滤器辅助治疗肾血管平滑肌脂肪瘤伴下腔静脉瘤栓1例报告

正肾血管平滑肌脂肪瘤(angiomyolipoma,AML)是最常见的肾脏良性间叶源性肿瘤,合并腔静脉瘤栓罕见。目前对于是否应用下腔静脉滤器预防肺栓塞存在争议。首都医科大学附属北京友谊医院近期收治AML伴下腔静脉瘤栓患者1例,现报告如下。1病例报告患者女性,51岁,因"右侧腰痛10余年,加重半     

腹腔镜治疗肾错构瘤并肾静脉及下腔静脉瘤栓1例并文献复习

目的：探讨全腹腔镜治疗肾错构瘤并肾静脉及下腔静脉瘤栓的可行性分析。方法：回顾性分析1例腹腔镜治疗肾错构瘤并肾静脉及下腔静脉瘤栓患者的临床资料。患者,女,26岁,体检时发现右肾占位,B超示右肾窦内可见5．1cm×2．7cm高回声占位,边界欠规则,内见血流。CT示右肾盂旁可见一不规则团块状混杂密度影,大小为4．5cm×2．9cm×1．9cm,可见脂肪成分,最低密度-40HU;病变软组织部分明显强化,增强前后CT值分别为31HU和97HU,病变主要位于肾窦,部分延伸至肾静脉及腔静脉内。检索Pubmed和CBM数据库相关文献进行复习。结果：患者在全麻下行腹腔镜右肾切除及肾静脉、下腔静脉取栓术,瘤栓进入下腔静脉0．6cm。病理诊断右肾错构瘤。术后随访6个月无肿瘤复发和转移。结论：肾错构瘤并。肾静脉及下腔静脉瘤栓临床罕见,对选择性病例行腹腔镜肾切除并行肾静脉及下腔静脉取栓术安全可行。     

Computerized tomographic demonstration of inferior vena caval tumor thrombus from renal angiomyolipoma

A case of renal angiomyolipoma with gross venous tumor thrombus extension into the inferior vena cava is presented. This fatty tumor thrombus is visualized easily by computerized tomography and is confirmed by inferior venacavography, surgery and histology. Macroscopic renal vein and vena caval tumor thrombi rarely occur in patients with angiomyolipoma and may be diagnosed preoperatively by the demonstration of abundant fat within the tumor components.     

Angiomyolipoma with a caval thrombus

We report the case of a female patient presenting with flank pain. Abdominal ultrasound revealed a tumor of 8 cm in diameter. After abdominal computerized tomography, the tumor was classified as angiomyolipoma with a tumor thrombus in the inferior vena cava. After nephrectomy, the diagnosis was confirmed histologically. To our knowledge, this is the 11th case of a renal angiomyolipoma extending into the vena cava.     

Benign Angiomyolipoma Involving the Renal Vein and Vena Cava as a Tumor Thrombus: Case Report

A 53-year-old woman presented with a renal angiomyolipoma extending as a thrombus into the renal vein and vena cava. This case is most unusual and we are unaware of any report of a benign angiomyolipoma that has presented as a tumor thrombus. The intravascular growth of a benign angiomyolipoma has previously been described.     

Rapidly growing renal angiomyolipoma during pregnancy with tumor thrombus into the inferior vena cava: a case report

A case of renal angiomyolipoma rapidly growing during pregnancy with tumor thrombus into the inferior vena cava is reported. Angiomyolipoma in a 31-year-old woman was incidentally found by ultrasonography. CT scan revealed a fat-containing tumor in the right kidney with 4 cm in diameter. The patient was followed at outpatient clinic without any treatment. Fifteen months later, the post-delivery follow-up CT scan showed that tumor size had grown up to 11 cm in diameter. Although laparoscopic right nephrectomy was tried, open transperitoneal right nephrectomy was performed because the tumor thrombus extending into the inferior vena cava was found during the laparoscopic procedure. Pathological diagnosis was angiomyolipoma of the kidney. There are several reports that indicate angiomyolipoma grows rapidly during pregnancy. Our case demonstrates that careful follow-up is required for angiomyolipoma in women with possible conception and delivery.     

Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma

BACKGROUND: We investigated the advantages of intraoperative transesophageal echocardiography (TEE) during inferior vena caval tumor thrombectomy in renal cell carcinoma (RCC). METHODS: Five patients with RCC that extended into the inferior vena cava (IVC) underwent radical nephrectomy. To remove the tumor thrombus in the IVC, an inflated Fogarty balloon catheter was used to pull the thrombus below the level of the hepatic veins with real-time TEE monitoring. RESULTS: In all cases, TEE monitoring during surgery provided an accurate and excellent view of the IVC thrombus. TEE was particularly helpful for the thrombectomy to minimize hepatic mobilization by using occlusion balloon catheter in two patients whose thrombus extended to the intrahepatic IVC. CONCLUSIONS: Intraoperative real-time TEE monitoring is a safe, minimally invasive technique that can provide accurate information regarding the presence and extent of IVC involvement, guidance for placement of a vena caval clamp, confirmation of complete removal of the IVC thrombus and intervention using catheters to assist in thrombectomy.