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学科主题: 泌尿外科学
题名:
肾癌合并右心房内癌栓的手术治疗及随访
其他题名: Surgical treatment and follow-up for renal cell carcinoma with tumor thrombus in inferior vena cava and right atrium
作者: 马潞林; 庞林涛; 王国良; 张树栋; 田晓军; 黄毅
关键词: 癌,肾细胞 ; 心房内癌栓 ; 手术治疗 ; Carcinoma,renal cell ; Atrial tumor thrombus ; Surgical therapy
刊名: 中华泌尿外科杂志
发表日期: 2015
DOI: 10.3760/cma.j.issn.1000-6702.2015.09.002
卷: 36, 期:9, 页:644-647
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 总结肾癌合并右心房内癌栓的手术治疗方法、疗效,以及随访情况.方法 回顾性分析2014年1月至2015年3月收治的3例肾癌合并右心房内癌栓患者的临床资料,均为男性.年龄50 ~64岁.均以无痛性肉眼血尿就诊.均经B超、CT、MR及食道超声检查确诊为肾癌合并右心房内癌栓.3例均联合肝胆外科、心脏外科在全麻下行根治性肾切除术及下腔静脉+心房内癌栓取出术.取肋缘下+胸部正中切口.首先游离肾,结扎肾动脉,游离下腔静脉.肝胆外科辅助游离肝脏,充分暴露肝上和肝下的下腔静脉,游离门静脉和肝动脉.心脏外科辅助开胸、建立体外循环及取出心房内癌栓.然后将肾和下腔静脉内癌栓取出.结果 3例手术均顺利完成,下腔静脉及心房内癌栓均顺利取出.手术时间480~589 min,体外循环时间40~ 110 min,术中出血量1 200~4 400 ml,输血量1 800 ~3 200 ml.1例于术后第17日因难治性败血症、呼吸衰竭、肾衰竭、凝血功能障碍等多器官功能衰竭死亡.1例于术后5个月发现肾上腺、肺及脑转移,并于术后7个月因全身多发转移死亡.1例术后随访1年,未发现肿瘤局部复发及远处转移.结论 肾癌合并右心房内癌栓患者的整体预后较差,根治性肾切除术+癌栓取出术安全、有效,是唯一有可能治愈的方法. Objective To evaluate the surgical treatment,effect and follow-up for renal cell carcinoma with tumor thrombus (T T) in inferior vena cava (IVC) and right atrium (RA).Methods Three cases of renal cell carcinoma with TT in IVC and RA diagnosed by Doppler ultrasonography,CT,MRI and transesophageal echocardiography were included in this retrospective analysis from January 2014 to March 2015 in our hospital.They were all male patients,aged from 50-64 years,and all patients presented painless gross hematuria.All patients underwent radical nephrectomy,inferior caval venous and atrial thrombectomy under general anesthesia,using abdomen inverted Y shaped incision and median sternal incision.Firstly,we dissected and ligated renal artery,then the vena cava was dissected;then hepatobiliary surgeons help to dissect the liver that can expose suprahepatic vena cava and inferior vena cava,and hepatic artery,hepatic portal vein;cardiothoracic surgeons help to perform sternotomy and establish cardiopulmonary bypass.Finally,TT in renal vein and IVC were extracted.Results All patients underwent radical nephrectomy,caval and atrial thrombectomy successfully.The operation time was 480-589 min,the extracorporeal circulation time was 40-110 min,the intraoperative blood loss was 1 200-4 400 ml,and the blood transfusion amount was 1 800-3 200 ml.Of the 3 patients,1 patient died on the 17th day of sepsis,respiratory failure,renal failure and coagulation disorders.One patient developed adrenal gland,lung and brain metastases in 5 months after surgery and died in 7 months after surgery.The remaining one is alive (follow-up:12 months) and without evidence of tumor recurrence or metastases.Conclusion For patients with renal cell carcinoma and TT in IVC and RA,although the overall prognosis is poor,radical nephrectomy plus caval and atrial thrombectomy is the only safe and effective therapeutic method.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/72414
Appears in Collections:北京大学第三临床医学院_泌尿外科_期刊论文

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作者单位: 100191,北京大学第三医院泌尿外科

Recommended Citation:
马潞林,庞林涛,王国良,等. 肾癌合并右心房内癌栓的手术治疗及随访[J]. 中华泌尿外科杂志,2015,36(9):644-647.
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