CAJ | 학술논문

目的提高肾和肾上腺恶性肿瘤伴下腔静脉瘤栓的治疗效果.方法 1985年1月至2008年4月收治肾和肾上腺恶性肿瘤合并下腔静脉瘤栓患者29例,均经彩色多普勒超声、CT及MRI检查确诊.瘤栓分型:I型7例、Ⅱ型10例、Ⅲ型8例、Ⅳ型4例.其中肾上腺肿瘤4例,肾肿瘤25例.TNM分期:T2NoMo 23例,T2N1Mo 1例,T2N1M1 1例,T3N.Mo 1例,T3N1M1 2例,T3N2Mo 1例.肿瘤平均直径8.7(4.O～16.0)cm.瘤栓平均长度:I型3.2(2.5～4.O)cm,Ⅱ型5.3(4.5～6.O)cm,Ⅲ型8.2(6.5～9.0)cm,IV型15.1(12.O～18.5)cm.29例均在全麻下行肾或肾上腺肿瘤根治性切除加下腔静脉瘤栓切除术.结果 29例手术均获成功.术后病理报告:肾透明细胞癌18例、肾肉瘤样癌3例、肾乳头腺癌2例、肾细胞癌(未分化型)1例、肾颗粒细胞癌1例、肾上腺皮质癌3例、肾上腺转移性恶性黑色索瘤1例.失访3例,余26例平均随访35(0～62)个月,患者3年生存率58%(15/26),5年生存率42%(11/26).T2、T3患者3年生存率分别为64%(14/22)、25%(1/4),5年生存率分别为45%(10/22)、25%(1/4).I、II、Ⅲ和Ⅳ型瘤栓患者3年生存率分别为4/6、5/8、5/8和1/4,5年生存率分别为3/6、4/8、3/8和1/4.膈肌以下瘤栓患者3、5年生存率分别为64%(14/22)、45%(10/22),膈肌以上瘤栓患者分别为1/4、1/4.肾和肾上腺恶性肿瘤伴下腔静脉瘤栓无转移患者的3、5年生存率为12/18、9/18,有转移患者分别为3/8、2/8.3例术前出现转移患者生存时间分别为6、10、22个月.结论根治性肿瘤切除和下腔静脉取栓治疗无淋巴和远处转移的肾和肾上腺恶性肿瘤合并下腔静脉瘤栓效果良好;即使存在远处转移,外科手术仍可以提高患者生活质量,延长患者生存期.
목적 제고신화신상선악성종류반하강정맥류전적치료효과.방법 1985년1월지2008년4월수치신화신상선악성종류합병하강정맥류전환자29례,균경채색다보륵초성、CT급MRI검사학진.류전분형:I형7례、Ⅱ형10례、Ⅲ형8례、Ⅳ형4례.기중신상선종류4례,신종류25례.TNM분기:T2NoMo 23례,T2N1Mo 1례,T2N1M1 1례,T3N.Mo 1례,T3N1M1 2례,T3N2Mo 1례.종류평균직경8.7(4.O～16.0)cm.류전평균장도:I형3.2(2.5～4.O)cm,Ⅱ형5.3(4.5～6.O)cm,Ⅲ형8.2(6.5～9.0)cm,IV형15.1(12.O～18.5)cm.29례균재전마하행신혹신상선종류근치성절제가하강정맥류전절제술.결과 29례수술균획성공.술후병리보고:신투명세포암18례、신육류양암3례、신유두선암2례、신세포암(미분화형)1례、신과립세포암1례、신상선피질암3례、신상선전이성악성흑색색류1례.실방3례,여26례평균수방35(0～62)개월,환자3년생존솔58%(15/26),5년생존솔42%(11/26).T2、T3환자3년생존솔분별위64%(14/22)、25%(1/4),5년생존솔분별위45%(10/22)、25%(1/4).I、II、Ⅲ화Ⅳ형류전환자3년생존솔분별위4/6、5/8、5/8화1/4,5년생존솔분별위3/6、4/8、3/8화1/4.격기이하류전환자3、5년생존솔분별위64%(14/22)、45%(10/22),격기이상류전환자분별위1/4、1/4.신화신상선악성종류반하강정맥류전무전이환자적3、5년생존솔위12/18、9/18,유전이환자분별위3/8、2/8.3례술전출현전이환자생존시간분별위6、10、22개월.결론 근치성종류절제화하강정맥취전치료무림파화원처전이적신화신상선악성종류합병하강정맥류전효과량호;즉사존재원처전이,외과수술잉가이제고환자생활질량,연장환자생존기.
Objective To discuss the treatment of renal or adrenal tumor with cancer thrombus in the inferior vena cava. Methods From Jan 1984 to Apr 2008,29 cases of renal or adrenal malignancy with thrombosis involving the inferior vena cava underwent treatment.The diagnoses were confirmed by Doppler uhrasonography,CT and MRI.In the 29 surgical patiens the tumor thrombus was level I in 7,level Ⅱ in 10,level Ⅲ in 8 and levelⅣin 4.According to TNM classification,23 cases were classified to T2N.M.,1 case was T2Nl Mo,1 case was TzNlMl,1 case was T3NoMo,2 case were T3NlMl and 1 case was T3N2Mo.The mean tumor size was 8.7(4.O-16.O)cm in diameter.The mean tumor thrombosis length was 3.2(2.5-4.0)cm in level I,5.3(4.5-6.0)cm in level Ⅱ,8.2(6.5-9.O)cm in levelⅢand 15.1(12.0-18.5)cm in level IV. Results The operation was performed succesgfullv in 29 patients Patholocieal examination showed that 18 cases of clear cellcarcinoma,3 cases sarcomatoid carcinoma,2 cases renal papillary adenocarcinoma,1 case renal cell carcinoma (undifferentiated),1 case granule carcinoma,3 cases adrenocortical carcinoma and 1 case metastatic malignant melanoma of adrenal gland.Of 29 patients,3 were out of contact.Twenty-six patients were followed up for 35(0-62)months after treatment,3-and 5-year survival rates were 15/26 and 11/26.Three-year survival rates for stage T2 and T3 were 14/22 and 1/4.Five-year survival rates for stage T2 and T3 were 10/22 and 1/4.Three-year survival rates for level I、Ⅱ、Ⅲ andⅣ were 4/6,5/8,5/8 and 1/4.Five-year survival rates for level I,Ⅱ、Ⅲ andⅣ were 3/6,4/8,3/8 and 1/4.Three-year survival rates for a tumor thrombus in the below or above diaphragm were 14/22 versus 1/4,5-year survival rates were 10/22 versus 1/4.Three-year and 5-year survival rates for the patients without distant metastases and lymph node involvement were 12/18 and 9/18.Three-year and 5-year surviral rates for the patients with distant metastases and lymph node involvement were 3/8 and 2/8.The 3 surgical patients with metastatic disease died at 6,10,22 months. Conclusions Surgical treatment could be the preferred approach for the patients of renal or adrenal tumor with cancer thrombus in the inferior vena cava without distant metastases and lymph node involvement.It could improve the quality of life and may prolong survival.