CAJ | 학술논문

目的探讨腔静脉内肿瘤的诊断和手术治疗. 方法回顾性研究近年来收治的6例腔静脉内肿瘤患者的临床资料,包括患者首发症状、主要临床表现、手术治疗过程和预后,对比研究B超、CTA、MRA等诊断方法.结果 6例患者术前均行B超检查;2例经CTA、4例经MRA确诊;累及心脏3例.均采取手术治疗,根据肿瘤生长范围,3例采取胸腹联合切口,于心包外阻断下腔静脉;3例体外循环下腹部正中切口和正中开胸切口,打开右心房;所有病例的肿瘤均完整切除且发现双瘤体1例.病理报告平滑肌瘤4例,平滑肌肉瘤2例.1例平滑肌肉瘤患者因术后肝功能衰竭死亡,其余术后均恢复良好.平均随访51个月未发现复发. 结论 B超、CTA、MRA对腔静脉内肿瘤均有诊断价值,MRA能提供多方位更清晰的解剖关系,有助于手术方法的选择.外科手术是腔静脉内肿瘤主要治疗方法,术中应探查腔静脉及髂总静脉的主要属支,盆腔来源肿瘤可以结扎髂内静脉,以预防复发.
목적 탐토강정맥내종류적진단화수술치료. 방법회고성연구근년래수치적6례강정맥내종류환자적림상자료,포괄환자수발증상、주요림상표현、수술치료과정화예후,대비연구B초、CTA、MRA등진단방법.결과 6례환자술전균행B초검사;2례경CTA、4례경MRA학진;루급심장3례.균채취수술치료,근거종류생장범위,3례채취흉복연합절구,우심포외조단하강정맥;3례체외순배하복부정중절구화정중개흉절구,타개우심방;소유병례적종류균완정절제차발현쌍류체1례.병리보고평활기류4례,평활기육류2례.1례평활기육류환자인술후간공능쇠갈사망,기여술후균회복량호.평균수방51개월미발현복발. 결론 B초、CTA、MRA대강정맥내종류균유진단개치,MRA능제공다방위경청석적해부관계,유조우수술방법적선택.외과수술시강정맥내종류주요치료방법,술중응탐사강정맥급가총정맥적주요속지,분강래원종류가이결찰가내정맥,이예방복발.
Objective To investigate the diagnosis and surgical treatment of intracaval venous tumors. Methods Clinical data of 6 cases were retrospectively analyzed, including signs and symptoms diagnostic means such as type-B ultrasound, CTA, MRA, surgical procedures and prognosis. Results All six cases received type-B ultrasonic examination, final definite diagnosis was achieved by CTA exam in 2 cases and through MRA in 4 cases. Heart involvement was found in 3 cases. All patients underwent a surgery. According to the extent of the tumor,3 cases had thoraco-abdominal incision,3 cases with extracorporeal circulation and right atrium opening. All of the tumors were completely resected. Pathological exam revealed that 4 cases were of leiomyomatosis and 2 cases were of leiomyosarcoma. One case with leiomyosarcoma died of liver disfunction postoperatively.The other 5 cases recovered without major complications. An average 51 months of follow-up found no recurrence. Conclusions CT and MRI are the mainstay for the diagnosis,and MRI can provide clear anatomy image to the surgeons, help choose the surgical procedures. The one-stage operation is effective. During the operation, the main branches of the vena cava system should be detected, and the attachment of the tumor should be found and removed thoroughly to prevent the recurrence of the tumor. When the attachment point is lower than the iliac vein level, ligation of the involved iliac vein should be mandatory.