下腔静脉、髂外静脉节段性切除且不重建血管在复杂腹盆腔肿瘤手术中的应用（附视频二维码）

目的 总结联合节段性切除下腔静脉、髂外静脉且不重建血管的复杂腹盆腔肿瘤手术的相关经验。方法 回顾性分析接受手术治疗且于术中节段性切除了下腔静脉、髂外静脉的11例腹盆腔复杂肿瘤患者的临床资料。结果 11例患者中结直肠癌术后转移3例,肾盂癌并癌栓、淋巴结转移2例,肾盂癌并淋巴结转移1例,输尿管癌并淋巴结转移1例,肾盂癌术后腹盆腔种植1例,宫颈癌术后转移1例,腹膜后平滑肌肉瘤1例,膀胱癌1例。涉及血管的手术包括：下腔静脉节段性切除5例,右侧髂外静脉节段性切除+右侧髂内动静脉节段性切除1例, 右侧髂内动静脉节段性切除+左侧髂外静脉节段性切除1例,下腔静脉节段性切除+双侧髂总静脉节段性切除+右侧髂总动脉与髂外动脉人工血管搭桥术1例,下腔静脉节段性切除+右侧髂外动脉静脉节段性切除+右侧髂外动脉人工血管置换1例,髂外静脉节段性切除2例。所有手术均顺利完成,手术时间570（390 ~ 900）min,术中输红细胞4（2 ~ 15）单位,输血浆600（150 ~ 1800）ml,术后住ICU 0（0 ~ 517） h。术后5例出现下肢静脉血栓,4例予以保守治疗后下肢水肿逐渐消退,1例予以介入溶栓治疗。结论 对于复杂的腹盆腔肿瘤,如肿瘤包绕、侵犯或粘连下腔静脉、髂外静脉,可考虑节段性切除累及的主干静脉,单纯结扎且不予重建,虽然术后有发生下肢静脉血栓的风险,但因此而导致的严重不良后果并非常见。

Application of segmental excision of inferior vena cava and/or external iliac vein without vascular reconstruction in complex surgeries for abdominal and pelvic tumors

Objective To summarize the experience of segmental excision of the inferior vena cava and/or external iliac vein without vascular reconstruction in complex surgeries for abdominal and pelvic tumors. Methods Clinical data of 11 patients undergoing complex surgeries for abdominal and pelvic tumors and segmental excision of the inferior vena cava and/or external iliac vein without vascular reconstruction were retrospectively analyzed. Results Among 11 cases, 3 patients developed postoperative metastases of colorectal cancer, 2 cases of renal pelvic cancer complicated with tumor thrombus and lymph node metastases, 1 case of renal pelvic cancer complicated with lymph node metastasis, 1 case of ureteral cancer complicated with lymph node metastasis, 1 case of abdominal implantation after surgery for renal pelvic cancer, 1 case of postoperative metastasis of cervical cancer, 1 case of retroperitoneal leiomyosarcoma and 1 case of bladder cancer. The surgeries involving blood vessels were performed including 5 cases of segmental resection of the inferior vena cava, 1 case of segmental resection of the right external iliac vein + segmental resection of the internal iliac artery and vein, 1 case of segmental resection of the right internal iliac artery and vein + segmental resection of the left external iliac vein, 1 case of segmental resection of the inferior vena cava + segmental resection of bilateral common iliac veins + prosthetic vessel bypass between the right common iliac artery and external iliac artery, 1 case of segmental resection of the inferior vena cava + segmental resection of the right external iliac artery and vein + prosthetic vessel replacement of the right external iliac artery and 2 cases of segmental resection of the external iliac vein, respectively. All patients successfully completed the surgeries. The median operation time was 570 （390 ~ 900） min. The median volume of intraoperative red blood cell infusion was 4 （2 ~ 15） units. The median volume of plasma transfusion was 600 （150 ~ 1800） ml. The median length of postoperative ICU stay was 0 （0 ~ 517） h. Postoperatively, venous embolism occurred in 5 cases. After conservative treatment, edema was gradually mitigated in 4 patients and international thrombolysis was delivered in 1 case. Conclusions For complex abdominal and pelvic tumors, such as tumor encasement, invasion or adhesion and of the inferior vena cava and external iliac vein, segmental resection of the involved major vein combined with ligation without vascular reconstruction can be considered. Although there is a risk of venous embolism of the lower limbs after surgery, it seldom causes severe adverse events.