CAJ | 학술논문

目的探讨体外循环下运用腹腔镜、胸腔镜联合小切口治疗肾癌合并Ⅳ级癌栓的可行性及安全性. 方法回顾性分析2011年8月至2013年5月5例肾癌合并Ⅳ级癌栓患者的临床资料.男4例,女1例.年龄46～67岁.均有无痛性肉眼血尿,腰痛3例,发热1例,均无下肢水肿或腹壁静脉曲张等下腔静脉阻塞表现.影像学检查均提示右肾占位,肿瘤直径8～13 cm,平均11 cm,下腔静脉癌栓长度为16～23 cm,平均19 cm.均在体外循环下运用腹腔镜、胸腔镜联合小切口行根治性肾切除和癌栓取出术. 结果 5例手术均成功,未发生癌栓脱落.手术时间330～ 420 min,平均370 min,其中血流阻断时间55～73 min,平均65 min.术后住院7～13d,平均9d.随访6～26个月,平均17个月.1例患者术后6个月死于脑转移,其余4例无复发及转移. 结论对于无淋巴结和远处转移的肾癌伴Ⅳ级癌栓形成的患者,在体外循环下腹腔镜、胸腔镜联合小切口治疗肾癌合并Ⅳ级癌栓有效且安全.
목적 탐토체외순배하운용복강경、흉강경연합소절구치료신암합병Ⅳ급암전적가행성급안전성. 방법 회고성분석2011년8월지2013년5월5례신암합병Ⅳ급암전환자적림상자료.남4례,녀1례.년령46～67세.균유무통성육안혈뇨,요통3례,발열1례,균무하지수종혹복벽정맥곡장등하강정맥조새표현.영상학검사균제시우신점위,종류직경8～13 cm,평균11 cm,하강정맥암전장도위16～23 cm,평균19 cm.균재체외순배하운용복강경、흉강경연합소절구행근치성신절제화암전취출술. 결과 5례수술균성공,미발생암전탈락.수술시간330～ 420 min,평균370 min,기중혈류조단시간55～73 min,평균65 min.술후주원7～13d,평균9d.수방6～26개월,평균17개월.1례환자술후6개월사우뇌전이,기여4례무복발급전이. 결론 대우무림파결화원처전이적신암반Ⅳ급암전형성적환자,재체외순배하복강경、흉강경연합소절구치료신암합병Ⅳ급암전유효차안전.
Objective To explore the feasibility and safety of combination of thoracoscopy and laparoscopy for the small incision surgical management of renal cell carcinoma and level Ⅳ tumor thrombus in inferior vena cava (IVC) by extracorporeal circulation.Methods The data,including preoperative diagnosis,operation pattern and prognosis,of 5 cases of renal cell carcinoma involving level Ⅳ tumor thrombus in IVC were analyzed retrospectively form Aug.2011 to May.2013.The 5 patients included 4 men and 1 woman aged from 46 to 67 years.All patients presented painless gross hematuria,3 cases with backache,1 case with fever,no case with lower extremity edema,abdominal wall varicosis or any other clinical manifestations due to obstruction of IVC.All the patients were examined with ultrasonography,computed tomography and magnetic resonance imaging which depicted lesions in the right kidney,tumor thrombus in IVC with a mean length of 19 cm (range 16-23 cm).All 5 cases were performed with radical resection of renal tumor and removal of tumor thrombus in IVC by combination of thoracoscopy and laparoscopy.Results All 5 cases were successfully performed with radical resection of renal tumor and removal of tumor thrombus in IVC.The shedding of the tumor thrombus did not occur in all cases.The mean operative time was 370 min (range 330-420 min) and the mean blood blocking time was 65 min (range 55-73 min).The average hospital stay was 9 d (range 7-13 d).With a mean follow-up of 17 months (6-26 months),1 patient died of brain metastasis at 6 months postoperatively.No recurrence or metastasis of tumors occurred in other patients.Conclusion For the patients without lymph node involvement and distant metastasis,combination of thoracoscopy and laparoscopy for the small incision surgical management of renal cell carcinoma and level Ⅳ tumor thrombus in IVC by extracorporeal circulation is feasible and safe.