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微创泌尿外科杂志  2022, Vol. 11 Issue (5): 342-346    DOI: 10.19558/j.cnki.10-1020/r.2022.05.011
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肾细胞癌合并下腔静脉癌栓的分级及微创手术治疗进展
李辉, 杨超, 汪凯红, 张亿达, 郭炬, 孙庭, 傅斌, 王共先, 曹润福*
南昌大学第一附属医院泌尿外科,南昌 330000
Grading and surgical treatment of renal cell carcinoma combined with inferior vena cava carcinoma thrombosis
Li Hui, Yang Chao, Wang Kaihong, Zhang Yida, Guo Ju, Sun Ting, Fu Bin, Wang Gongxian, CaoRunfu*
Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang 330000, China
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摘要 4%~10%的晚期肾细胞癌会侵犯静脉系统,其中22%~70%会累及下腔静脉。未经治疗的肾癌伴下腔静脉癌栓患者中位生存期仅为5个月。根治性肾切除联合下腔静脉取栓手术的30d死亡率为1.5%~10%,术后5年特异性生存率为40%~60%。手术应遵循每一类静脉癌栓对应一类手术策略的原则,不同侧需要不同技术。术前需要行CT或MRI检查充分评估下腔静脉癌栓情况,围手术期患者的管理对手术的成功也至关重要。Ⅰ级和Ⅱ级癌栓优选腹腔镜或机器人手术,Ⅲ级和Ⅳ级癌栓建议术前先行靶向药物治疗,待癌栓缩小或降级后再行手术治疗。
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李辉
杨超
汪凯红
张亿达
郭炬
孙庭
傅斌
王共先
曹润福
关键词 肾细胞腔静脉微创    
Abstract:In 4%-10% of cases of advanced RCC, the venous system is involved, of which 22% to 70% involve the inferior vena cava.Median survival was only 5 months in untreated patients with renal cancer and thrombolism of the inferior vena cava.The 30-day mortality from radical nephrectomy combined with inferior vena cava thrombectomy was 1.5%-10%, and the 5-year specific survival rate was 40%-60%.Surgery should follow the principle that each type of venous carcinoma thrombosis corresponds to a class of surgical strategy, and different techniques are required on different sides.Preoperative CT or MRI is required to adequately evaluate inferior vena cava carcinoma thrombosis, and perioperative patient management is critical to surgical success.Grades I and II carcinoma thrombosis favors laparoscopy or robotic surgery. Grades III and IV carcinoma thrombosis suggests targeted drug therapy before surgery, followed by surgery after reduction or downgrade of the carcinoma thrombosis.
Key wordscarcinoma    renal cell    vena cava    inferior    microtrauma
收稿日期: 2022-07-25     
通讯作者: 曹润福,cao-r-f@163.com   
引用本文:   
李辉, 杨超, 汪凯红, 张亿达, 郭炬, 孙庭, 傅斌, 王共先, 曹润福. 肾细胞癌合并下腔静脉癌栓的分级及微创手术治疗进展[J]. 微创泌尿外科杂志, 2022, 11(5): 342-346.
Li Hui, Yang Chao, Wang Kaihong, Zhang Yida, Guo Ju, Sun Ting, Fu Bin, Wang Gongxian, CaoRunfu. Grading and surgical treatment of renal cell carcinoma combined with inferior vena cava carcinoma thrombosis. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(5): 342-346.
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