CAJ | 학술논문

目的探讨巨大肿瘤侵犯下腔静脉时,单纯切除和结扎下腔静脉的安全性和可行性.方法回顾性分析2008-2011年收治的4例腹部巨大肿瘤合并下腔静脉侵犯患者,行肿瘤及所侵犯的肝下下腔静脉切除术,病例1和2左肾静脉回流不受影响,术后下腔静脉未予重建,病例3肝左静脉受侵部分也被切除,肝左静脉断端通过人工血管与右心房吻合.病例4行肝右三叶切除,肝后下腔静脉切除并远端关闭,肝左静脉与肝上下腔静脉断端吻合.结果 4例患者巨大肿瘤及受侵犯的下腔静脉顺利切除并结扎,术中无大出血及死亡,术后发生水肿1例,胆漏1例,均治愈.Ewin肉瘤患者1年后死于肿瘤复发,未出现肾功不良及其他腔静脉并发症.韧带纤维瘤患者术后下肢长期回流不畅、水肿,2年后第4次行复发肿瘤切除.结论当腹部巨大肿瘤侵犯下腔静脉需行联合切除时,若周围侧支循环充分建立且在术中没有被广泛破坏,而肝脏、肾脏等重要脏器的回流又能得到充分保证的前提下,可以将病变的下腔静脉予以切除、结扎,而不再重建下腔静脉.
목적 탐토거대종류침범하강정맥시,단순절제화결찰하강정맥적안전성화가행성.방법 회고성분석2008-2011년수치적4례복부거대종류합병하강정맥침범환자,행종류급소침범적간하하강정맥절제술,병례1화2좌신정맥회류불수영향,술후하강정맥미여중건,병례3간좌정맥수침부분야피절제,간좌정맥단단통과인공혈관여우심방문합.병례4행간우삼협절제,간후하강정맥절제병원단관폐,간좌정맥여간상하강정맥단단문합.결과 4례환자거대종류급수침범적하강정맥순리절제병결찰,술중무대출혈급사망,술후발생수종1례,담루1례,균치유.Ewin육류환자1년후사우종류복발,미출현신공불량급기타강정맥병발증.인대섬유류환자술후하지장기회류불창、수종,2년후제4차행복발종류절제.결론 당복부거대종류침범하강정맥수행연합절제시,약주위측지순배충분건립차재술중몰유피엄범파배,이간장、신장등중요장기적회류우능득도충분보증적전제하,가이장병변적하강정맥여이절제、결찰,이불재중건하강정맥.
Objective To evaluate the safety and feasibility of simple ligation and resection of the tumor involved inferior vena cava (IVC) without reconstruction during the resection of huge intraabdominal tumors.Methods From 2008 to 2011,4 cases of giant tumor encroaching on inferior vena cava underwent resection without IVC reconstruction.After resection,renal vein was not obstructed in patient 1 and 2.Tumor invaded the third patient's retrohepatic inferior vena cava,anastomosis was performed between the left hepatic vein and the opening of atrium dextrum with artificial vascular graft.The forth patient had right trisegmentectomy of the liver with retrohepatic inferior vena cava resection,anastomosis was performed between the left hepatic vein and the remaining inferior vena cava.Results All 4 patients had a successful operation without intraoperative massive bleeding and death.The postoperative complications included edema in one patient whose collateral circulation was damaged and bile leak in one.Ewin sarcoma patient died of tumor recurrence after a year,but there was no sign of poor renal function and other complications.Ligament fibroma patient had lower limb edema for a long time after the surgery,and tumor relapse for the fourth time in two years following resection.Conclusions When a giant tumor involving and invading IVC,undergoing resection,under the condition that the collateral circulations around IVC established completely,resection and ligation of the inferior vena cava along with huge tumor without IVC reconstruction is safe.This method saves operation time,increases the safety of surgery.