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肾癌伴腔静脉瘤栓是相当罕见的,仅见于近3％的肾癌。因其它疗法效果太差,故手术摘除瘤栓仍是主要疗法。作者对54例伴腔静脉瘤栓的肾癌患者行根治性肾切除和腔静脉切开、瘤栓摘除术,其中5例行受累腔静脉部分切除,2例行腔静脉完全切除,另外3例在摘除瘤栓后结扎腔静脉。所有患者均摘除了可见瘤栓。手术死亡率为9.3％(5例),3例死于肺栓塞,1例死于术中心肌梗塞,1例死于术后内出血。术后明显并发症有4例:心内膜下心肌梗塞1例,术后肺栓塞1例,术后暂时性肾衰2例(为腔静脉切除伴左肾静脉结扎者),缺血性肝炎1例。术前未发现转移的36例患者中29例完全摘除瘤栓,7例未能完全摘除,5年存活率分别为68％和
Kidney cancer with vena cava tumor thrombus is quite rare, only seen in nearly 3% of kidney cancer. Due to the poor effect of other therapies, surgical removal of tumor thrombi is still the main treatment. The authors performed radical nephrectomy, vena cava excision, and tumor thrombectomy in 54 patients with renal cell carcinoma with vena cava tumor thrombus. Among them, 5 patients underwent partial excision of the vena cava, 2 patients underwent complete vena cava excision, and another 3 patients. The vena cava was ligated after removing the tumor plug. All patients were removed from visible tumor plugs. The operative mortality rate was 9.3% (5 cases), 3 died of pulmonary embolism, 1 died of intraoperative myocardial infarction, and 1 died of postoperative internal hemorrhage. There were 4 postoperative complications: 1 case of subendocardial myocardial infarction, 1 case of postoperative pulmonary embolism, 2 cases of postoperative temporary renal failure (who had vena cava excision with left renal vein ligation), and ischemic hepatitis 1 case. Thirty-six patients who did not find metastasis before surgery found that 29 patients had completely removed tumor thrombi and 7 patients had not been completely removed. The 5-year survival rate was 68%, respectively.