完全后腹腔镜下治疗肾癌合并Mayo分级0级静脉癌栓18例报告

摘要

Objective To investigate the safety and feasibility of total retroperitoneal laparoscopy in the treatment of renal carcinoma with level 0 tumor thrombus. Methods Clinical data of 18 cases of renal cancer combined with Mayo level 0 intravenous tumor thrombus from January 2015 to October 2017 in our hospital were analyzed retrospectively.If sufficient length of the renal vein could be freed in laparoscopy,we used Hem-o-lok clip to cut off the renal vein.If not, we used the auricular clamp or transfered to open operation to resect the tumor emboli. Results The inferior vena cava was blocked by the auricular clamp in 2 cases.The 18 cases of Mayo level 0 intravenous tumor thrombus were all successfully performed.Total laparoscopic surgery was performed in 16 cases.The kidney and tumor thrombus were dissected under laparoscopy and then were resected with open incision in 2 cases.The operation time was 60-240 min(median,120 min)and the intraoperative blood loss was 10-200 ml(median,80 ml).No blood transfusion was required.Follow-ups in 17 cases for 1-33 months(median,12 months)found no cancer recurrence or matastasis. Conclusion Retroperitoneal laparoscopy is safe and effective for the treatment of renal carcinoma with Mayo level 0 tumor thrombus.%目的 探讨完全后腹腔镜治疗肾癌合并Mayo分级0级癌栓的安全性和可行性. 方法 2015年1月~2017年10月对18例肾癌合并Mayo分级0级静脉癌栓行完全后腹腔镜下患肾和癌栓切除.如果在腹腔镜下可以游离出癌栓远端的肾静脉,用Hem-o-lok夹闭后切断,如果无法游离出足够长的肾静脉,需要使用侧壁钳或开放切除癌栓. 结果 术中心耳钳部分阻断下腔静脉2例.18例Mayo 0级肾癌合并静脉癌栓手术均顺利完成,其中完全后腹腔镜手术16例,腹腔镜下完全游离,再中转开放手术切除患肾及癌栓2例.手术时间60~240 min,中位数120 min;术中出血量10~200 ml,中位数80 ml,均未输血.17例随访1~33个月,中位数12个月,未见肿瘤复发、转移. 结论 后腹腔镜治疗肾癌合并Mayo分级0级癌栓安全、有效.