CAJ | 학술논문

目的：探讨后腹腔镜联合开放手术治疗肾癌合并Ⅳ级下腔静脉瘤栓的安全性及临床效果。方法2004年2月至2014年8月我院肾癌合并Ⅳ级下腔静脉瘤栓患者7例，采用肾癌根治性切除加深低温停循环下腔静脉瘤栓取出术。4例为开放手术，3例为后腹腔镜联合开放手术。结果7例患者手术均成功完成。与开放手术组相比，后腹腔镜组的出血量和切口长度明显减少（P＜0．05）。两组间的平均手术时间、深低温停循环时间、术后住院时间无明显统计学差异（P＞0．05）。1例患者因术后出血死亡，余6例围手术期无重大并发症发生。随访4～108个月，2例因肺转移于术后2年内死亡，4例患者存活。结论后腹腔镜联合开放手术可以缩短切口长度、减少出血量、降低手术创伤。
목적：탐토후복강경연합개방수술치료신암합병Ⅳ급하강정맥류전적안전성급림상효과。방법2004년2월지2014년8월아원신암합병Ⅳ급하강정맥류전환자7례，채용신암근치성절제가심저온정순배하강정맥류전취출술。4례위개방수술，3례위후복강경연합개방수술。결과7례환자수술균성공완성。여개방수술조상비，후복강경조적출혈량화절구장도명현감소（P＜0．05）。량조간적평균수술시간、심저온정순배시간、술후주원시간무명현통계학차이（P＞0．05）。1례환자인술후출혈사망，여6례위수술기무중대병발증발생。수방4～108개월，2례인폐전이우술후2년내사망，4례환자존활。결론후복강경연합개방수술가이축단절구장도、감소출혈량、강저수술창상。
ABSTRACT:Objective To explore the efficacy and safety of retroperitoneal laparoscopy combined with open surgery for renal cell carcinoma with level IV vena cava thrombus .Methods Clinical data of 7 cases of renal cell carcinoma and level IV inferior vena cava thrombus treated during Feb .2004 to Aug .2014 were retrospectively analyzed .Cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) was applied for thrombectomy in all patients .Four patients under‐went simple open surgery ,and 3 patients underwent retroperitoneal laparoscopy combined with open surgery .Results All operations were technically successful .The tumor and vena cava thrombus were completely resected and no invasion of the ca‐val wall was observed .One patient died of postoperative bleeding .Compared with the retroperitoneal laparoscopic group ,the open surgery group had more blood loss and longer incision length (2737 .5 vs .850 mL ,60 .5 vs .47.7 cm ,both P< 0 .05) . There was no difference in operation time ,circulatory arrest time and postoperative hospitalization time between the two groups (P>0 .05) .During the follow‐up of 4 to 108 months (mean 46 .3 months) ,2 patients died due to lung metastasis in month 22 and 24 respectively ,and 4 patients were alive .Conclusions Retroperitoneal laparoscopy combined with open sur‐gery could significantly reduce blood loss and incision length .