CAJ | 학술논문

目的报告局限性肾癌肾部分切除术后复发并下腔静脉瘤栓的处理经验. 方法 2013年5月收治1例肾癌肾部分切除术后复发并下腔静脉瘤栓患者,男,37岁患者2年前因右肾上极肿物于外院行腹腔镜下肾部分切除,术后病理为肾细胞癌.患者术后未复查.2013年5月,患者出现右侧腰疼,CT、MRI、PET-CT等检查发现右肾中上极复发性恶性肿瘤,右侧腰大肌、后腹壁、肾周、输尿管上段区等多发种植转移瘤,肿瘤侵及下腔静脉并腔静脉内瘤栓;多发淋巴结、右第12肋可疑转移.肝脏、肺部、脑、其他骨骼等未见转移.全麻下行右肾、受侵组织及腔静脉瘤栓切除. 结果手术成功,手术时问6h,术中出血4 000 ml.切口一期愈合,2周后出院.术后病理:右肾中上部肿瘤并侵及肾实质、肾被膜;肾下极周围脂肪内、输尿管上段、腰大肌肿物组织可见癌;部分腔静脉组织及腔静脉瘤栓可见癌.病理特点符合乳头状肾细胞癌Ⅱ型.肾静脉内、肾门血管、淋巴结等均其他部位未见癌.术后随访1年,复查CT未见肿瘤复发及明显肿瘤遗存. 结论肾癌保肾术后局部复发而无远处转移时,首选手术切除局部肿瘤侵及的组织、脏器,术后给予靶向治疗,可提高无瘤生存时间.
목적 보고국한성신암신부분절제술후복발병하강정맥류전적처리경험. 방법 2013년5월수치1례신암신부분절제술후복발병하강정맥류전환자,남,37세 환자2년전인우신상겁종물우외원행복강경하신부분절제,술후병리위신세포암.환자술후미복사.2013년5월,환자출현우측요동,CT、MRI、PET-CT등검사발현우신중상겁복발성악성종류,우측요대기、후복벽、신주、수뇨관상단구등다발충식전이류,종류침급하강정맥병강정맥내류전;다발림파결、우제12륵가의전이.간장、폐부、뇌、기타골격등미견전이.전마하행우신、수침조직급강정맥류전절제. 결과 수술성공,수술시문6h,술중출혈4 000 ml.절구일기유합,2주후출원.술후병리:우신중상부종류병침급신실질、신피막;신하겁주위지방내、수뇨관상단、요대기종물조직가견암;부분강정맥조직급강정맥류전가견암.병리특점부합유두상신세포암Ⅱ형.신정맥내、신문혈관、림파결등균기타부위미견암.술후수방1년,복사CT미견종류복발급명현종류유존. 결론 신암보신술후국부복발이무원처전이시,수선수술절제국부종류침급적조직、장기,술후급여파향치료,가제고무류생존시간.
Objective To report the clinical features,management and prognosis of local recurrence with inferior vena cava tumor thrombus for renal cell carcinoma after laparoscopic partial nephrectomy.Methods A case of 37-year-old man was admitted to hospital for recurrent renal tumor in May 2013.The patient undervent laparoscopic partial nephrectomy for right kidney mass in June 2011,and renal cell carcinoma was diagnosed by pathological examination.The patient complained about pain of right flank in May 2013.Imaging examination (including CT,MRI and PET-CT) showed a 5 cm tumor on the upper-middle right kidney associated with inferior vena cava tumor thrombus,bulky retroperitoneal lymph nodes and extensive local invasion including psoas,ureter,perirenal fascia.Surgical excision of local recurrence,nephrectomy plus inferior vena eava thrombectomy was performed.Results Right nephrectomy and local recurrence incision plus inferior vena eava thrombectomy was performed successfully.The operation time was 360 min,blood loss was 4 000 ml.The patient was discharged on the 14th day after surgery.The pathological characteristics were as follows:the tumor was limited to the upper-middle right kidney,psoas,ureter,and inferior vena cava tumor thrombus,but carcinoma was not found in the lymph nodes,pelvis and others.The final pathological diagnosis was papillary renal cell carcinoma,type Ⅱ.Local recurrence and other distant metastasis were not demonstrated with CT in 12 months' follow-up.Conclusion Excision of locally recurrent renal cell carcinoma is possible,and complete surgical resection could lead to prolonged disease-free survival.