肾癌伴下腔静脉癌栓的手术治疗

目的探讨手术治疗肾癌伴下腔静脉癌栓的效果。方法回顾性分析2004年10月至2006年3月共5例肾癌伴下腔静脉癌栓患者的临床资料,男3例,女2例,平均49.8岁。5例均为右侧,肾静脉型(Ⅰ型)1例,肝下型(Ⅱ型)2例,肝内型(Ⅲ型)2例。均行肾癌根治性切除加下腔静脉切开取栓术。结果1例因癌栓脱落引起肺栓塞术中死亡外,余4例手术顺利。1例癌栓侵犯腔静脉壁,术后局部复发和肺部转移,17个月死亡。其余3例分别随访7个月、9个月、23个月,均未发现肿瘤复发和远处转移。结论对于未发现有远处转移的肾癌下腔静脉癌栓,肾癌根治性切除加下腔静脉切开取栓术是积极有效的治疗方法。

The operative treatment of renal cell carcinoma with inferior vena cava tumor thrombus

Objective To evaluate the operative treatment of renal cell carcinoma(RCC) with inferior vena cava tumor thrombus.Methods From October 2004 to March 2006,5 patients(3 male,2 female) with inferior vena cava tumor thrombus underwent radical nephrectomy and thrombectomy.The median age was 49.8 years.Of the 5 patients,1 was renal vein thrombus,2 were infrahepatic thrombus,2 were hepatic thrombus.Results The operation were success in 4 of the 5 patients and 1 patients died because of lung embolism induced by tumor thrombus defluvium.The 4 patients had been followed up for 7～23 months after surgery.1 patient died of tumor recurrence and metastasis at the 17th month after surgery and the others survived without recur and distant metastasis.Conclusions The radical nephrectomy plus thrombectomy is the preferred approach for patients without metastasis.