摘要
目的探讨原发性下腔静脉平滑肌肉瘤的手术治疗。方法回顾性分析山东大学附属省立医院血管外科2009年10月-2011年5月收治的5例原发性下腔静脉平滑肌肉瘤患者，均行手术治疗，采用肿瘤及受累下腔静脉切除、人工血管重建双。肾静脉及远端下腔静脉血流的术式。结果本组5例患者平均手术时间为166．6min，术中平均失血量为1560mL。术中观察肿瘤均累及下腔静脉以及右肾静脉，瘤体平均大小为12cm×10cm×8cm，术后均经病理证实为平滑肌肉瘤。本组术后无下肢肿胀发生，监测。肾功能、血尿素氮及血浆肌酐清除率水平，均在正常范围内。5例患者均顺利出院，出院后继续口服华法林抗凝治疗。随访3—12个月，超声检查人工血管桥通畅，无肺栓塞发生。结论肿瘤及受累下腔静脉切除、人工血管重建双肾静脉及远端下腔静脉血流的术式治疗原发性下腔静脉平滑肌肉瘤，可最大程度地切除肿瘤组织和保留重要脏器功能，最小程度地影响血流动力学和减少肺栓塞的发病率。
Objective To discuss the surgical therapy of primary leiomyosarcoma of the inferior vena cava（PIVCLS）. Methods Retrospective analysis of was made 5 patients of PIVCLS from Oct 2009 to May 2011 hospitalized in Department of Vascular Surgery, Provincial Hospital Affiliated to Shandong University. All patients underwent surgical resection, combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft. Results Surgical resection was performed successfully in all patients. The mean operation time was 166.6 min, with mean blood loss 1 560 mL. Leiomyosarcoma intruding the inferior vena cava and right renal vein were observed in all patients during operation. The mean size was 12 cm × 10 cm × 8 cm. The diagnosis of PIVCLS in 5 patients was confirmed by postoperative pathologic examination. All patients did not present lower extremity swelling after surgery and discharged from hospital with normal blood （BUN） and （CREA）. All patients were administrated with oral warfarin therapy after discharge. No clinical relapse and pulmonary embolism was observed during the follow-up （range 3 months to 12 months）. The uhrasound revealed the patency of artificial vascular grafts in all patients. Conclusions Surgical resection combined with reconstruction of bilateral renal vein and distal inferior vena cava using artificial vascular graft is an effective and feasible treatment of PIVCLS. Leiomyosarcoma is completely eliminated and important abdominal viscera are protected well during the procedure because of minimal impact on hemodynamics. The incidence of postoperative pulmonary embolism also decreases obviously.
出处
《国际外科学杂志》
2011年第12期812-814,F0003,共4页
International Journal of Surgery
关键词
下腔静脉
平滑肌肉瘤
人工血管
Inferior vena cava
Leiomyosarcoma
Artificial vascular graft
