深低温停循环辅助下切除肾或肾上腺肿瘤及下腔静脉瘤栓

目的：提高肾或肾上腺肿瘤伴下腔静脉瘤栓的治疗效果。方法：1999年12月～2006年3月收治7例肾及肾上腺恶性肿瘤伴下腔静脉瘤栓完全梗阻患者,下腔静脉瘤栓均位于肝静脉平面以上,采用在深低温停循环技术辅助下,完整切除肿瘤及下腔静脉瘤栓。结果：1例术后19d死于多器官功能衰竭;其余6例随访9～64个月,平均24个月,2例术前确诊肺转移患者分别生存29和8个月死于肺、脑转移;1例术后2个月发现肺部转移,现存活22个月;其余3例仍存活,未发现肿瘤局部复发或远处转移。结论：深低温停循环技术使手术在无血手术野中进行,良好地暴露了手术视野,在无明显延长手术时间的前提下切除了肿瘤及腔静脉内的瘤栓,提高了手术的安全性和成功率。该术式改善了患者的生活质量,延长了生存期。     

Improving surgical outcomes in renal cell carcinoma involving the inferior vena cava

Radical nephrectomy with tumor thrombectomy remains the mainstay of treatment in renal cell carcinoma with inferior vena cava extension. Despite the rapid improvements experienced in perioperative care in recent years, this intervention still often results in significant morbidity and mortality. A deeper understanding of salient features of this complex operation provides a valuable insight into the clinical mechanisms underlying the variations observed in surgical outcomes. The ‘operation profile’ serves not only as a basis for making an adequate prognostic assessment, but also creates a platform from which ‘innovative’ strategies for improving quality and safety can be made. The present review aims to set a ‘profile’ for radical nephrectomy and tumor thrombectomy, and to propose a number of strategies that may reduce the complication rates of this intervention.     

Surgical treatment of renal cell carcinoma with tumor thrombi in the inferior vena cava

Background We evaluated the results of surgical treatment for renal cell carcinoma with tumor thrombi in the inferior vena cava. Methods Between March 1984 and July 1996, 25 patients were surgically treated for renal cell carcinoma with extension to the inferior vena cava. Inferior vena caval thrombosis was classified as supradiaphragmatic in 3 patients and infradiaphragmatic in 14 patients. Thrombi were also detected around the renal vein in 8 patients. Twenty-three patients underwent transperitoneal radical nephrectomy, and thrombectomy. One patient with bilateral renal cancer underwent right nephrectomy, left partial nephrectomy, and thrombectomy. The remaining patient underwent nephrectomy and an incomplete thrombectomy due to massive hemorrhage during surgery. In 10 patients with an inferior vena caval diameter of >40 mm, a partial cardiopulmonary bypass was used during surgery. After removal of tumor thrombi, simple closure of the caval wall was performed in 14 patients, Gore-Tex^™ (W.L. Gore & Associates, Elkton, MD, USA) patch grafting, in 10 patients, and inferior vena caval replacement with Gore-Tex, in 1 patient. Results The 1-, 3- and 5-year cause-specific survival in all patients was (72%, 50%, and 23%), respectively. The mortality rate was (8%). There was no significant difference in cause-specific survival according to tumor thrombi level. However, the cause-specific survival of patients with metastasis to either regional lymph node or distant organs, or both (n=10), was significantly lower compared to that of patients without metastasis (n=15); the 3-year cause-specific survival was (17%) and (59%) in the metastasis group and the non-metastatic group, respectively (P=0.042).) Conclusion These results indicate that removal of tumor thrombi in the inferior vena cava is a safe and useful treatment for renal cell carcinoma with no metastasis.     

肾癌伴下腔静脉癌栓的外科治疗

目的：探讨肾癌伴下腔静脉癌栓的外科治疗。方法：回顾分析2004年5月-2008年10月16例经手术及病理证实的肾癌伴下腔静脉癌栓患者的资料,行肾癌根治术及静脉癌栓取出术,其中男性11例、女性5例,下腔静脉癌栓I级（肝下水平）11例、Ⅱ级（肝后水平）3例、Ⅲ级（肝上水平）1例、Ⅳ级（右心房水平）1例。结果：13例患者得到随访,平均随访（19±4．3）个月（6—48个月）,2例失访,1例死亡。结论：肾癌根治性切除加癌栓取出术是治疗肾癌伴下腔静脉癌栓的有效方法。     

体外循环在腹部肿瘤伴发肝后下腔静脉癌栓手术中的应用

2000年4月至2005年4月间,我们将体外循环技术应用于7例腹部恶性肿瘤伴发肝后下腔静脉(inferior vena cava,IVC)癌栓的手术治疗中,取得了一定的经验,现将结果报道如下。一、资料与方法1.临床资料:本组患者男5例,女2例;年龄40～80岁,     

肾癌下腔静脉癌栓的诊断和手术方法的探讨--附6例临床分析并文献复习

背景与目的:肾癌下腔静脉癌栓临床处理困难,肾癌根治性切除的同时再切除肾静脉癌栓和取出下腔静脉癌栓,预后仍然良好。术前明确诊断,特别是对癌栓延伸范围的判断,对手术方式的选择十分重要。本研究结合我们的经验,进一步探讨肾癌下腔静脉癌栓的诊断和手术治疗。方法:回顾性分析我院2000～2004年收治的6例肾癌并发下腔静脉癌栓患者的临床资料,包括诊断方法、手术治疗和预后。结果:6例患者术前均经B超、CT和MRI明确诊断,肾静脉型1例,肝下型3例,肝内型2例;1例肝内型患者术中死亡,余5例均手术成功。术后随访3～30个月,1例肝下型和1例肝内型患者分别于术后9个月、3个月死于远处转移,其余3例仍存活。结论:CT、MRI是目前无创诊断肾癌伴下腔静脉癌栓的最佳方法;对无淋巴结和远处转移的患者,应积极手术治疗;手术方式的选择取决于癌栓的延伸范围以及是否侵犯下腔静脉壁。     

减瘤手术联合靶向治疗在转移性肾癌合并下腔静脉癌栓治疗中的临床价值

目的:探讨减瘤手术联合靶向治疗转移性肾癌(metastatic renal cell carcinoma,mRCC)合并下腔静脉癌栓患者的安全性和有效性。方法:回顾性分析2011年11月至2019年02月收治的13例mRCC合并下腔静脉癌栓患者的临床资料,根据有无靶向治疗分为靶向组和非靶向组。靶向组8例,男7例,女1例,平均年龄(48.38±13.92)岁,肿瘤位于左侧5例,右侧3例,平均直径(9.93±5.37)cm。非靶向组5例,男4例,女1例,平均年龄(60.60±5.37)岁,肿瘤位于左侧1例,右侧4例,平均直径(11.24±2.76)cm。结果:术后病理:靶向组透明细胞癌6例,乳头状肾细胞癌和肉瘤样癌各1例,术后TNM分期T3bN1M0和T4N1M1各1例,T3aN1M1 3例,T3bN1M1 3例。非靶向组透明细胞癌2例,Xp11.2易位/TFE3基因融合相关性肾癌、乳头状肾细胞癌和低分化癌各1例,术后TNM分期T3bN1M1和T3cN1M1各1例,T4N1M1 3例。所有患者获随访4～47个月,中位随访时间27个月。靶向组和非靶向组中位无进展生存期分别为6.5个月和2个月,半年、1年无进展生存率分别为50.00%(4/8)、37.50%(3/8)和40.00%(2/5)、20.00%(1/5),两组对比无统计学差异(HR=0.46,95%CI:0.13~1.70,P=0.125 9)。靶向组和非靶向组中位总生存期分别为41个月和8个月,1年和2年总存活率分别为100.00%(8/8)、87.50%(7/8)和20.00%(1/5)、20.00%(1/5),两组对比统计学差异显著(HR=0.17,95%CI:0.03~0.99,P=0.000 5)。结论:减瘤手术治疗mRCC并下腔静脉癌栓患者安全有效,术后进行靶向治疗可显著延长患者总生存期。     

肾癌腔静脉癌栓的诊断与治疗

背景与目的：肾癌可侵犯肾静脉,形成癌栓延伸至腔静脉,甚至右心房。肾癌腔静脉癌栓临床处理困难,但是在根治性肾切除时取尽癌栓,患者可获得长期生存。本文报告我们处理肾癌腔静脉癌栓的体会。方法：回顾性分析1995年5月～2003年10月经手术治疗的14例肾癌腔静脉癌栓患者的临床资料,包括术前诊断、手术方法和患者的预后。结果：B超发现腔静脉癌栓9例,漏诊5例;CT诊断癌栓12例,漏诊2例;8例MR1检查均发现腔静脉癌栓并对癌栓范围显示清楚。14例中肝下腔静脉癌栓12例、肝内膈下和膈上腔静脉癌栓各1例,术后随访时间6～37个月,13例无瘤生存,1例(ⅢC患者)于术后23个月因癌死亡。结论：B超和CT是诊断肾癌腔静脉癌栓常用方法,MR1判断癌栓范围较B超和CT准确。对没有淋巴和远处转移的肾癌腔静脉癌栓患者外科治疗能获良好的远期效果。     

Renal cell carcinoma extending into the vena cava: a multi-institute study.

The present paper reports the clinical results from cases of renal cell carcinoma with vena caval tumor thrombus. Fifty patients were entered into the study between 1980 and 1989. The primary tumor and vena caval tumor thrombus were completely removed in 39 (78%) patients, and 41 (82%) received postoperative treatment. The overall 12-, 36-, 60- and 90-month actuarial survival rates were 72, 41, 19 and 10%, respectively. Only tumor stage affected survival, however, other factors such as tumor grade, nodal status, metastatic status and level of vena caval involvement not affecting it. Postoperative interferon (IFN) treatment affected survival, whereas degree of curative surgery did not. The results of our study were, however, examined retrospectively in several institutes. Further investigation of the postoperative treatment for renal cell carcinoma with vena caval tumor thrombus will be necessary.     

肾细胞癌合并腔静脉癌栓诊治体会（5例报告并文献复习）

目的:探讨肾细胞癌合并腔静脉癌栓患者临床特点、诊断、综合治疗原则。方法:回顾性分析我院收治的5例肾细胞癌合并腔静脉癌栓患者临床资料并文献复习。其中3例接受开放肾癌根治性切除+癌栓取出术,1例接受腹腔镜下肾癌根治性切除+癌栓取出术,1例行靶向药物治疗。结果:4例手术均成功,手术平均时间213.7 min（135~315） min,术中平均出血量1 650.0 ml（600~3 500） ml,术后病理学诊断均为肾透明细胞癌,术中、术后未出现明显并发症,平均随访时间为12.2(5~30)个月,影像学复查未见明显复发、远处转移表现。结论:肾细胞癌合并腔静脉癌栓患者治疗上以根治性手术为主,条件合适患者可采用腹腔镜等微创手术方式,术前充分评估,术中多学科合作、严密监测、预防癌栓脱落,术前采用新辅助靶向药物治疗可能降低癌栓等级、手术难度。     

Proton beam therapy for hepatocellular carcinoma with inferior vena cava tumor thrombus: report of three cases

Three patients with hepatocellular carcinoma (HCC) and inferior vena cava tumor thrombus (IVCTT) were treated using proton beam therapy at the University of Tsukuba, Japan. A total dose of 50-70 Gy in 10-35 fractions was given to the primary tumor and IVCTT. All the patients survived for more than 1 year from the beginning of proton beam therapy (13-55 months) and no treatment-related toxicity of grade 3 or higher was observed. These cases suggest that proton beam therapy is safe and effective for patients with HCC associated with IVCTT.     

Leiomyosarcoma of the inferior vena cava

Leiomyosarcoma of the inferior vena cava is a rare primary tumour. We present a case report of a 67‐year‐old man with a long history of abdominal pain and gastroesophageal reflux, who was found to have a large retroperitoneal mass confirmed to be a leiomyosarcoma. The clinical and imaging features are outlined, and in addition the treatment and prognosis.     

Aneurysms of the inferior vena cava

Two cases of saccular aneurysms of the infrarenal inferior vena cava (IVC) associated with retrohepatic IVC obstruction are described. Ultrasonographic, computerized tomographic and inferior venacavography findings in these cases are presented.     

恶性肿瘤所致上腔静脉综合征的外科治疗

  恶性肿瘤所致上腔静脉综合征因为其位置特殊，手术难度大，预后差。结合相关文献就恶性肿瘤所致上腔静脉综合征的适应证，手术技巧，效果等作一简要概述。     

Primary leiomyosarcoma of the inferior vena cava: a case report and review of the literature

Sixty-six cases of leiomyosarcoma of the inferior vena cava (IVC) have been reported. We present another case and review the characteristics and treatment of this rare tumor. IVC leiomyosarcomas spread by extension into adjacent tissue planes. Direct extension into the heart is known, but not into the kidneys, adrenals, or bowel. IVC leiomyosarcomas arising below the renal vein cause pain in the right-lower quadrant, back, and flank, and varying degrees of lower extremity edema; those arising in the middle caval segment cause right-upper-quadrant pain and sometimes renovascular hypertension; those arising above the hepatic vein cause varying manifestations of the Budd-Chiari syndrome. A reasonable approach to early diagnosis involves oral and intravenous contrast studies followed by computed tomography, angiography, and vena cavography. Aggressive surgical treatment is optimal in light of the tumor's slow growth pattern and relatively low malignant potential. (Metastases have been reported in fewer than 50% of cases). Tumors involving the lower IVC are most amenable to surgery; extensive collateral venous drainage of the left kidney preserves renal function during resection of middle caval tumors. Upper caval leiomyosarcomas are the least amenable to complete removal. Postoperative survival of all patients has ranged from a few weeks to eight years.