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目的探讨肾癌伴Ⅳ级下腔静脉癌栓,在癌栓未进入右心房及未侵犯下腔静脉壁的情况下,非体外循环辅助下的手术治疗。方法对肾癌伴Ⅳ级下腔静脉癌栓患者6例,采取非体外循环辅助下实施标准的根治性肾切除和腔静脉癌栓取出术。结果手术均获得成功,未出现大出血及肺梗塞,术后肾功能正常。随访1例Ⅲ期T3CN1M0型术后16个月CT检查发现肺转移,术后18个月死亡。5例随访18个月,均未发现肿瘤复发和远处转移。结论肾癌伴Ⅳ级下腔静脉癌栓,采取非体外循环辅助下的手术治疗是安全可行的方法之一。
Objective To investigate the renal cancer with grade IV vena cava tumor thrombus, under the circumstance that the tumor thrombus did not enter the right atrium and not invaded the inferior vena cava wall, and the operation was assisted by off-pump. Methods Six patients with renal cell carcinoma with IVC thrombolysis were treated with standard radical nephrectomy and vena cava tumor thrombectomy with the help of off-pump. Results All the operations were successful. No major bleeding or pulmonary infarction occurred. The postoperative renal function was normal. One case of type Ⅲ T3CN1M0 was followed up for CT examination at 16 months after operation. Lung metastasis was observed and died after 18 months. Five cases were followed up for 18 months. No tumor recurrence and distant metastasis were found. Conclusions Renal carcinoma with IV grade IV tumor thrombosis is one of the safe and feasible methods to take surgical treatment assisted by off-pump.