摘要
目的探讨转移性肾细胞癌伴肾静脉或下腔静脉癌栓患者行减瘤性肾切除术及静脉癌栓取出术的安全性和有效性。方法回顾性分析2015年2月至2019年5月北京大学第三医院收治的56例转移性肾细胞癌伴静脉癌栓且行手术治疗患者的病例资料。男44例(78.6%),女12例(21.4%)。平均年龄(59.2±10.7)(22~82)岁。临床表现仅有局部症状26例(46.4%),仅有全身症状8例(14.3%),同时合并局部症状和全身症状12例(21.4%),无症状者10例(17.9%)。肾肿瘤位于右侧35例(62.5%),左侧21例(37.5%)。肿瘤直径平均(10.1±3.8)(1.5~21.1)cm。美国麻醉医师协会评分2分45例(80.4%),3分11例(19.6%)。术前血红蛋白(118.2±23.1)(72~178)g/L,白蛋白(37.9±5.6)(23~50)g/L,总蛋白(67.7±6.7)(43~81)g/L,血肌酐(111.3±119.6)(32~958)μmol/L。静脉癌栓Mayo分级0级16例(28.6%),Ⅰ级14例(25.0%),Ⅱ级17例(30.4%),Ⅲ级4例(7.1%),Ⅳ级5例(8.9%)。临床淋巴结分期cN0期14例(25.0%),cN1期42例(75.0%)。单纯骨转移5例(8.9%),单纯肺转移16例(28.6%),单纯肾上腺转移2例(3.6%),单纯肝转移6例(10.7%),≥2个部位的多系统转移27例(48.2%)。56例共发现91处转移灶,发生肺转移37处(40.7%),肝转移18处(19.8%),骨转移21处(23.1%),肾上腺转移15处(16.5%)。56例均为国际转移性肾细胞癌联合数据库(IMDC)预后评分中危组。采用腹腔镜手术22例(39.3%),开放手术30例(53.6%),4例(7.1%)腹腔镜手术中转开放手术。Mayo 0级癌栓的手术处理方法同根治性肾切除术。MayoⅠ级癌栓主要采用satinsky心耳钳部分阻断下腔静脉后取栓。MayoⅡ级癌栓需要依次阻断癌栓远心端腔静脉、对侧肾静脉及近心端腔静脉后切开下腔静脉取栓。MayoⅢ级癌栓需要游离肝脏并采用Pringer法阻断第一肝门后取栓。MayoⅣ级癌栓可采用切开膈肌中心腱或直接切开膈肌取栓,或采用体外循环取栓。6例(10.7%)因肿瘤侵犯血管壁切除下腔静脉壁。32例(57.1%)因术前影像学提示
Objective To investigate the safety and effectiveness of cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with renal vein or inferior vena cava tumor thrombus.Methods From February 2015 to May 2019,56 cases of metastatic renal cell carcinoma with venous tumor thrombus were analyzed retrospectively,including 44 male(78.6%)and 12 female(21.4%)cases,and the average age was(59.2±10.7)(22-82).The clinical presentations covered local symptoms in 26 cases(46.4%),systemic symptoms in 8 cases(14.3%),both local symptoms and systemic symptoms in 12 cases(21.4%),and asymptomatic in 10 cases(17.9%).Among them,renal tumors were located in 35 cases(62.5%)on the right and 21 cases(37.5%)on the left.The average tumor diameter was(10.1±3.8)(1.5-21.1)cm.Forty-five cases(80.4%)scored 2 points and 11 cases(19.6%)scored 3 points by the American Society of anesthesiologists(ASA).Preoperative hemoglobin was(118.2±23.1)(72-178)g/L,and albumin was(37.9±5.6)(23-50)g/L,total protein was(67.7±6.7)(43-81)g/L,serum creatinine was(111.3±119.6)(32-958)μmol/L.There were 16 cases of Mayo 0(28.6%),14 cases of MayoⅠ(25.0%),17 cases of MayoⅡ(30.4%),4 cases of MayoⅢ(7.1%),and 5 cases of MayoⅣ(8.9%).Fourteen cases(25.0%)were in the stage of cN0 and 42 cases(75.0%)in the stage of cN1.Five cases(8.9%)had simple bone metastasis,16 cases(28.6%)had simple lung metastasis,2 cases(3.6%)had simple adrenal metastasis,6 cases(10.7%)had simple liver metastasis,and 27 cases(48.2%)had 2 or more multiple system metastasis.According to the location of the organ system,91 metastatic lesions were found in 56 patients.Among them,37 cases(40.7%)had lung metastasis,18 cases(19.8%)had liver metastasis,21 cases(23.1%)had bone metastasis and 15 cases(16.5%)had adrenal metastasis.All 56 patients belonged to IMDC prognosis score model medium risk group.The surgical treatment of Mayo grade 0 tumor thrombus was the same as that of routine radical nephrectomy.The tumor thrombus of Mayo gradeⅠwas removed after IVC was parti
作者
刘茁
赵勋
朱国栋
唐世英
洪鹏
张启鸣
李丽伟
张树栋
王国良
田晓军
张洪宪
刘承
马潞林
iu Zhuo;Zhao Xun;Zhu Guodong;Tang Shiying;Hong Peng;Zhang Qiming;Li Liwei;Zhang Shudong;Wang Guoliang;Tian Xiaojun;Zhang Hongxian;Liu Cheng;Ma Lulin(Department of Urology,the Third Hospital of Peking University,Beijing 100083,China;Department of Ultrasound Diagnosis,the Third Hospital of Peking University,Beijing 100083,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第6期415-420,共6页
Chinese Journal of Urology
关键词
癌
肾细胞
减瘤性肾切除术
下腔静脉
转移癌
癌栓
Carcinoma
renal cell
Cytoreductive nephrectomy
Inferior vena cava
Metastatic carcinoma
Tumor thrombus
