肾癌伴腔静脉癌栓的手术配合

目的探讨肾癌伴腔静脉癌栓手术的护理配合方法。方法回顾性分析54例肾癌伴腔静脉癌栓患者的临床资料,总结手术前、中、后的护理配合方法和技巧。结果 54例患者中4例因经济困难放弃手术治疗,2例因术中癌栓脱落死亡,余48例均顺利完成手术,无明显并发症,痊愈出院。结论术前详细讨论、精心准备,术中严密配合可以使手术顺利进行,缩短静脉阻断时间,减少并发症,促进患者康复。     

肝细胞癌合并下腔静脉癌栓的手术治疗

目的 探讨肝细胞癌(简称肝癌)合并下腔静脉癌栓的手术治疗方法。方法 采用肝切除 腔静脉取栓治疗4例肝癌合并下腔静脉癌栓患者,取栓方法包括经荷栓肝静脉取栓(1例)和下腔静脉切开取栓(3例),后者又分在全肝血流阻断下取栓(2例)和在萨氏钳局部血管阻断下取栓(1例)。结果 4例肝癌及下腔静脉癌栓均得到成功切除,术中无明显并发症发生;术后除l例发生中等量胸水外,无其他并发症发生;随访中3例已死亡,分别生存30、10和14个月;1例尚存活,已生存7个月。结论 肝癌合并下腔静脉癌栓的手术治疗安全可行,其基本术式为肝切除 下腔静脉切开取栓。     

采用一种新的经腹切开膈肌方法治疗肝癌合并膈上下腔静脉癌栓

肝癌合并下腔静脉癌栓是晚期肝癌的表现，以往认为手术治疗效果很差。随着外科技术的发展，手术治疗不仪能去除原发灶，而且能解除癌栓脱落造成心力衰竭和肺动脉栓寒。福建省市阪院收治了1例肝癌合并膈上下腔静脉癌栓患者，旨在探讨肝癌合并下腔静脉癌栓手术过程中经腹切开膈肌显露脯上下腔静脉的新方法。     

Transitional cell carcinoma of the renal pelvis forming tumor thrombus in the vena cava

A 47-year-old man presented with a left renal incidentaloma without hematuria. The tumor was complicated by inferior vena cava (IVC) thrombus extending from Th11 to L4. A temporary IVC filter was introduced prior to surgery. A midline incision was used to perform a left radical nephrectomy and en bloc lymphadenectomy with excision of the inferior vena cava from above the level of the left renal vein to 2.5 cm above the confluence of the common iliac veins. The pathological diagnosis was invasive transitional cell carcinoma. The tumor thrombus consisted of transitional cell carcinoma that histologically invaded the walls of the IVC. He died of cancer 17 months after the operation for the liver metastases. This is the 18th case report of such a presentation in the literature.     

血管介入技术在治疗肾癌伴下腔静脉瘤栓中的应用

肾癌伴下腔静脉瘤栓以手术治疗为主,传统手术创伤大、风险高,手术方式也一直发展变化,而血管介入技术的发展和应用,使此类手术更为安全和方便.本文总结了肾动脉介入、下腔静脉滤器、球囊和血管镜在治疗肾癌伴下腔静脉瘤栓中的应用.     

肾上腺恶性嗜铬细胞瘤并下腔静脉瘤栓形成的诊治分析(附5例报告)

目的:探讨肾上腺恶性嗜铬细胞瘤并下腔静脉瘤栓形成的临床诊疗经验。方法:回顾性分析5例肾上腺恶性嗜铬细胞瘤并下腔静脉瘤栓形成患者的临床资料:患者24h尿VMA均升高,尿儿茶酚胺定性试验均阳性;CT、CTA、下腔静脉造影检查发现下腔静脉充盈缺损。5例均在全麻下行肾上腺肿瘤切除加下腔静脉瘤栓取出术。结果:目前3例生存,另2例分别于术后21个月和36个月死亡。结论:影像学检查(CT、CTA、下腔静脉造影等)对肾上腺恶性嗜铬细胞瘤并下腔静脉瘤栓形成的诊断具有重要意义。根治性肿瘤切除加瘤栓取出术是治疗肾上腺恶性嗜铬细胞瘤并下腔静脉瘤栓形成的有效方法。     

En bloc mobilization of the inferior vena cava and large hypervascular right renal tumors with or without inferior vena cava thrombus: Posterior ligation of the renal artery

We describe our approach of posterior ligation of the renal artery during resection of large hypervascular right renal tumors. This technique uses en bloc mobilization of the inferior vena cava and renal tumor to ligate the renal artery at its origin from the aorta. In our experience, the use of this posterior approach for renal artery ligation is safe and effective, even with large renal tumors with multiple collaterals and/or lymph nodes making the identification of the renal artery difficult.     

Thymic carcinoma with tumor thrombus into the superior vena cava

Tumor thrombus into the vena cava have been reported in cases with renal cell carcinoma, thyroid tumor and in those with thymoma. These tumors are frequently invasive and continuous from the main tumor that shows direct vessel wall invasion. Here, we report a case of thymic carcinoma with superior vena cava syndrome, which was caused by a tumor thrombus in the superior vena cava without vessel wall invasion. The main mediastinal tumor did not show innominate vein invasion, and the superior vena cava syndrome was a result of separate tumor thrombus that was free of vessel wall invasion. The tumor thrombus could be removed through a simple venotomy. To prevent stenosis in the superior vena cava and the left innominate vein, we used a pericardial patch to close the venotomy site.     

Successful management of inferior vena cava thrombus complicating advanced germ cell testicular tumor with temporary inferior vena cava filter

We report a case of right testicular tumor with inferior vena cava (IVC) thrombus. Due to the risk of pulmonary embolization, a temporary IVC filter had been inserted during chemotherapy. There were no complications with the temporary IVC filter during the implantation period. The patient was safely treated with systemic chemotherapy using a temporary IVC filter followed by retroperitoneal lymph node and vena cava dissection.     

腹膜后肿瘤伴下腔静脉癌栓的外科处理

目的：探讨腹膜后肿瘤伴下腔静脉癌栓患者的分期和分型及外科处理。方法：2例右肾癌伴下腔静脉癌栓和1例右肾上腺皮质癌伴下腔静脉癌栓，分别行右肾癌或右肾上腺皮质癌根治性下腔静脉部分切除或切开取栓术。结果：2例术后分别存活48个月和12个月，1例术中死亡。结论：根据患者的分期和分型采用不同的手术方法，是治疗本病的有效途径。     

肾细胞癌合并下腔静脉癌栓患者发生术后早期并发症的临床分析

目的 分析手术治疗肾细胞癌合并下腔静脉癌栓术后早期并发症的发生情况.方法 回顾性分析2015年2月-2016年4月北京大学第三医院泌尿外科收治的27例肾细胞癌合并下腔静脉癌栓患者的临床资料.27例患者中,男性21例,女性6例.年龄47～84岁,平均(61.7±9.8)岁々体重指数为17.6 ～ 30.8 kg/m2,平均(22.2±2.9) kg/m2.右侧肾细胞癌合并下腔静脉癌栓者18例,左侧者9例.肿瘤直径为3.6 ～21.1 cm,平均(8.5±3.6)cm.下腔静脉癌栓分级(美国Mayo医学中心分级法):0级6例(22.2％),Ⅰ级6例(22.2％),Ⅱ级8例(29.6％),Ⅲ级5例(18.5％),Ⅳ级2例(7.4％).行腹腔镜下肾癌根治性切除术+下腔静脉癌栓取出术者14例,行开放肾癌根治性切除术+下腔静脉癌栓取出术者13例.采用改良Clavien分级系统评估术后早期并发症.≥Ⅲ级并发症定义为严重并发症.结果 本组27例患者中,14例出现术后早期并发症(51.9％).发生乳糜漏2例,予饮食控制及皮下注射生长抑素后治愈;发生下肢静脉血栓3例,予低分子肝素治疗后好转;发生术后肺部感染3例,予抗生素抗感染治疗后治愈;发生双侧大腿皮疹1例,考虑为抗生素所致过敏有关,予停用致敏药物,静脉滴注维生素C及葡萄糖酸钙处理后治愈.术后严重并发症者5例(18.5％),包括术后腹腔积液1例,行B超引导下穿刺引流后好转;术后肾功能不全合并高钾血症者2例,行血液透析治疗后好转;发生术后血压下降、心搏骤停1例,发生术后低氧血症、感染中毒性休克及多器官功能不全1例,此2例患者均死亡.结论 肾癌根治性切除术和下腔静脉癌栓取出术治疗肾细胞癌合并下腔静脉癌栓患者存在发生术后早期并发症甚至严重并发症的可能.充分了解并发症发生原因及特点,加强预防和及时有效的处理,是降低其发病率的关键措施.     

Renal arteriovenous malformation with thrombus in the inferior vena cava

BACKGROUND: Thrombus formation in the inferior vena cava (IVC) is usually seen in cases with malignancy. In contrast, vascular anomalies hardly ever accompany this disorder. Herein, a case of thrombus formation in the IVC associated with renal arteriovenous malformation (AVM) is reported. METHODS/RESULTS: A 50-year-old woman who received transarterial embolization (TAE) for AVM in the right kidney noticed right flank pain with macrohematuria 12 months later. Because radiographic evaluation could not rule out malignancy in the kidney, nephrectomy was performed. During nephrectomy, a palpable thrombus was found in the IVC, so thrombectomy was performed simultaneously. Histopathologic examination revealed an old infarction due to the TAE, circumferential arteriovenous thrombi and a large organized thrombus up to the IVC, but neither renal cell carcinoma nor transitional carcinoma in the kidney. CONCLUSIONS: Careful observation may be required, even after treatment for renal AVM, such as TAE, to avoid the formation of an IVC thrombus.     

Functional paraganglioma with tumor thrombus in the inferior vena cava,first case report

Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and ¹³¹I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.     

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。     

The loss of BAP1 protein expression predicts poor prognosis in patients with nonmetastatic clear cell renal cell carcinoma with inferior vena cava tumor thrombosis

Objectives

Renal cell carcinoma (RCC) is characterized by a propensity for extension into the renal vein and inferior vena cava (IVC) and is associated with poor prognosis. BAP1 mutation, which occurs in about 15% of patients with clear cell RCC (ccRCC), also predicts poor prognosis. The aim of this study was to elucidate the association between BAP1 protein expression and clinicopathological outcomes in patients with nonmetastatic ccRCC with an IVC tumor thrombus (IVCTT).

Testicular cancer with tumor thrombus extending to the inferior vena cava successfully removed using veno-venous bypass: A case report

A 33-year-old man with a left testicular tumor was referred to Shinshu University Hospital for advanced therapy. Radiographic imaging revealed multiple metastases in the retroperitoneal lymph nodes (RPLN) and bilateral lungs, as well as tumor thrombus that extended from the left renal vein to the inferior vena cava (IVC) adjacent to the right atrium. After orchidectomy, a diagnosis of embryonal carcinoma was made with a clinical stage of T1N2M1bS3, which has a poor prognosis, based on the International Germ Cell Cancer Collaborative Group consensus. After eight courses of chemotherapy, the patient's tumor markers normalized and the lung metastases disappeared, but the RPLN and tumor thrombus remained. Retroperitoneal lymph node dissection and thrombectomy were performed using a veno-venous bypass (VVB). The pathological examination of the thrombus revealed a mature teratoma. The patient has been disease-free since surgery.