CAJ | 학술논문

目的探讨手术治疗复杂重症下腔静脉恶性肿瘤的方法及其效果.方法 2004年12月至2008年7月对8例下腔静脉肿瘤行手术治疗,其中7例患者8次在体外循环或右心房插管灌注下手术切除下腔静脉肿瘤或(和)延及右心房/室内肿瘤;1例下腔静脉平滑肌肉瘤局部复发行下腔静脉置换术.术前CT或MRI检查均已除外远处转移.结果 1例患者于术后2个月死于肝衰竭,其他7例术后症状均缓解并顺利出院.7例患者随访5～45个月,平均(15±4)个月.其中3例术后随访14～24个月,效果良好,无复发;3例术后4、5及32个月后原位复发并全身多处转移,其中1例是罕见的下腔静脉多形性恶性纤维组织细胞瘤,5个月后复发并右肾上腺转移癌,9个月后再次切除下腔静脉及右心房/室内肿瘤,术后11个月第3次复发死于心衰;另2例复发者未再次手术,其中1例术后7个月行化疗后症状缓解.1例45个月后失访.结论对于复杂腔静脉恶性肿瘤如未发现其他部位转移可采取积极手术治疗,如此可明显改善患者近期生存质量.
목적 탐토수술치료복잡중증하강정맥악성종류적방법급기효과.방법 2004년12월지2008년7월대8례하강정맥종류행수술치료,기중7례환자8차재체외순배혹우심방삽관관주하수술절제하강정맥종류혹(화)연급우심방/실내종류;1례하강정맥평활기육류국부복발행하강정맥치환술.술전CT혹MRI검사균이제외원처전이.결과 1례환자우술후2개월사우간쇠갈,기타7례술후증상균완해병순리출원.7례환자수방5～45개월,평균(15±4)개월.기중3례술후수방14～24개월,효과량호,무복발;3례술후4、5급32개월후원위복발병전신다처전이,기중1례시한견적하강정맥다형성악성섬유조직세포류,5개월후복발병우신상선전이암,9개월후재차절제하강정맥급우심방/실내종류,술후11개월제3차복발사우심쇠;령2례복발자미재차수술,기중1례술후7개월행화료후증상완해.1례45개월후실방.결론대우복잡강정맥악성종류여미발현기타부위전이가채취적겁수술치료,여차가명현개선환자근기생존질량.
Objective To explore the surgical strategy and effects for treating complex malignant tumors of the inferior vena cava (IVC) or/and the tumors extending into right atrium/ventricle.Methods Between Dec 2004 and Jul 2008, eight patients underwent surgical resections, among those seven patients with tumors of IVC or the tumors extending into right atrium/ventricle were operated on under deep hypothermia with cardiopulmonary bypass( CPB), and one patient with recurrence of leiomyosarcoma of the IVC successfully underwent en bloc resection and caval reconstruction. The prosthetic graft was used for IVC reconstruction in two patients and vascular patch in the other two patients. Preoperative chest roentgenography, computed tomography, ultrasonography, or magnetic resonance imaging was used to exclude the presence of metastatic disease, to assess local resectability of the tumour and the extent of involvement and obstruction of the IVC. Results One patient died of liver failure postoperatively. The postoperative course was uneventful in other 7 patients. On follow-up two patients died 2 and 5 months later due to functional disorder of the liver. Three patients have been followed up for 14 - 24 months and were