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目的评价手术治疗肾细胞癌合并下腔静脉瘤栓的疗效。方法回顾分析38例经手术治疗的肾细胞癌合并下腔静脉瘤栓患者的临床资料。结果 38例患者中,男28例,女10例,平均年龄56岁;右肾癌伴腔静脉瘤栓31例,左肾癌伴腔静脉瘤栓7例;Ⅰ级瘤栓8例,Ⅱ级24例,Ⅲ级3例,Ⅳ级3例。所有患者均行肾癌根治切除及取瘤栓术,其中35例下腔静脉阻断下切除下腔静脉瘤栓,3例瘤栓达右心房,在体外循环腔静脉心房分流下取瘤栓。围手术期无死亡病例。随访6～114个月,平均41个月,21例无瘤生存(55.2%),2例复发转移带瘤生存(5.2%),13例肿瘤转移死亡(34.2%),2例失访。结论没有转移的肾细胞癌合并下腔静脉瘤栓如能完整切除,并非手术禁忌和愈后不良的因素。
Objective To evaluate the efficacy of surgical treatment of renal cell carcinoma complicated with inferior vena cava tumor thrombus. Methods The clinical data of 38 patients with renal cell carcinoma complicated with inferior vena cava thrombus treated by surgery were retrospectively analyzed. Results Among the 38 patients, 28 were male and 10 were female, with a mean age of 56 years. There were 31 cases of right renal cell carcinoma with caval thrombosis, 7 cases of left renal carcinoma with caval vein tumor thrombus, 8 cases of grade I tumor suppository, 24 cases, Ⅲ grade in 3 cases, Ⅳ grade in 3 cases. All patients underwent radical nephrectomy and tumor embolization. Among them, 35 cases of inferior vena cava tumor thrombus were excised with inferior vena cava occlusion and 3 cases of tumor thrombus with right atrium. Thrombus embolization was performed in extracavitating ventricular atrium. Perioperative death cases. The patients were followed up for 6 to 114 months with an average of 41 months. 21 patients survived without disease (55.2%), 2 patients survived (5.2%) with tumor recurrence, and 13 patients (34.2%) died of tumor metastasis. Conclusion No metastasis of renal cell carcinoma combined with inferior vena cava tumor suppositories, such as complete resection, is not a taboo for surgery and adverse prognosis factors.