CAJ | 학술논문

目的探讨完全腹腔镜下根治性肾切除及静脉癌栓取出术的可行性及安全性.方法回顾性分析2013年1月至2014年12月收治的13例肾肿瘤伴静脉癌栓患者的临床资料,男9例,女4例.年龄30～78岁,中位值55岁.7例因体检发现肾肿瘤,6例临床表现分别为血尿(4例)及腰痛(2例).伴肾静脉癌栓7例,下腔静脉癌栓6例.13例均采用完全腹腔镜手术方式,肾静脉癌栓患者行完全后腹腔镜下根治性肾切除及癌栓取出术;下腔静脉癌栓患者采用经腹腔入路腹腔镜手术(2例)或经后腹腔联合腹腔入路腹腔镜手术(4例).联合入路手术先于后腹腔镜下控制肾动脉、处理腰静脉及侧支循环血管,随后在经腹腔入路下完成下腔静脉癌栓取出.结果 13例手术均顺利完成,手术时间84 ～456 min,中位值195 min.肾静脉癌栓患者术中出血量50 ～150 ml,中位值50 ml.下腔静脉癌栓患者出血量100 ～2 500 ml,中位值325ml.13例术后均恢复良好,无严重并发症.术后病理检查:肿瘤最大径平均值(7.9±2.5) cm;肾透明细胞癌11例,嫌色细胞癌1例,骨肉瘤肾转移1例.术后随访时间2～22个月,中位值13个月,无死亡病例.2例分别于术后13、17个月发生双肺转移,1例于术后9个月发生腰椎转移.结论完全腹腔镜下根治性肾切除及静脉癌栓取出术安全可行,且可达到良好的肿瘤控制效果.经后腹腔联合腹腔入路腹腔镜手术可以有效结合两种入路的优势,方便术中操作.
목적 탐토완전복강경하근치성신절제급정맥암전취출술적가행성급안전성.방법 회고성분석2013년1월지2014년12월수치적13례신종류반정맥암전환자적림상자료,남9례,녀4례.년령30～78세,중위치55세.7례인체검발현신종류,6례림상표현분별위혈뇨(4례)급요통(2례).반신정맥암전7례,하강정맥암전6례.13례균채용완전복강경수술방식,신정맥암전환자행완전후복강경하근치성신절제급암전취출술;하강정맥암전환자채용경복강입로복강경수술(2례)혹경후복강연합복강입로복강경수술(4례).연합입로수술선우후복강경하공제신동맥、처리요정맥급측지순배혈관,수후재경복강입로하완성하강정맥암전취출.결과 13례수술균순리완성,수술시간84 ～456 min,중위치195 min.신정맥암전환자술중출혈량50 ～150 ml,중위치50 ml.하강정맥암전환자출혈량100 ～2 500 ml,중위치325ml.13례술후균회복량호,무엄중병발증.술후병리검사:종류최대경평균치(7.9±2.5) cm;신투명세포암11례,혐색세포암1례,골육류신전이1례.술후수방시간2～22개월,중위치13개월,무사망병례.2례분별우술후13、17개월발생쌍폐전이,1례우술후9개월발생요추전이.결론 완전복강경하근치성신절제급정맥암전취출술안전가행,차가체도량호적종류공제효과.경후복강연합복강입로복강경수술가이유효결합량충입로적우세,방편술중조작.
Objective To evaluate the feasibility and safety of pure laparoscopic radical nephrectomy and thrombectomy for patients with renal tumor and venous tumor thrombus.Methods From January 2013 to December 2014,data of patients with renal tumor and venous thrombus,treated in our institute,were retrospectively reviewed.There were nine male patients and four female patients.All patients' age ranged from 30 to 78 years old (median 55 years old).Seven patients were diagnosed by routine medical examination,while six patients had clinical symptoms,including four with gross hematuria and two with flank pain.Thirteen patients,including seven patients with renal vein (RV) thrombus and six patients with inferior vena cava (IVC) thrombus,were underwent pure laparoscopic radical nephrectomy and thrombectomy.Retroperitoneal approach was undertaken for RV thrombus patients,while transperitoneal approach or combined retroperitoneal and transperitoneal approach for IVC thrombus patients.During the combined approach surgery,renal artery and lumbar vein were controlled through retroperitoneal approach,and the thrombectomy procedure was completed through transperitoneal approach.Results All patients underwent operations successfully.Operation time ranged from 84 to 456 min (median 195 min).The blood loss ranged from 50 to 150 ml (median 50 ml) for RV tumor thrombus patients and 100 to 2 500 ml (median 325 ml) for IVC tumor thrombus patients.All patients recovered well after surgery without major complications.The pathological results showed the average tumor maximum diameter was 7.9 ± 2.5 cm.Eleven cases were diagnosed as clear cell renal cell carcinoma.One case was diagnosed as chromophobe renal cell carcinoma and one case was diagnosed as renal metastatic osteosarcoma in our study.Median follow-up time was 13 months,ranged from 2 to 22 months.No death was recorded at the last follow-up.Distant metastasis was found in three patients,including two patients with multiple pulmonary metastases and one patient with lumbar vertebral metastasis.Conclusions Pure laparoscopic radical nephrectomy and thrombectomy is feasible and safe,with ideal oncological prognosis.Combined retroperitoneal with transperitoneal procedures can take both the advantages of these two approaches and simplify the operative manipulations.