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时间:2020-04-14
《后腹腔镜联合开放治疗肾癌Ⅳ级下腔静脉瘤栓-论文.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、306JModUrol,Vo1.20No.5May.2015·临床研究·后腹腔镜联合开放治疗肾癌Ⅳ级下腔静脉瘤栓纪长威,张古田,王强,赵晓智,连惠波,张士伟,郭宏骞(南京大学医学院附属鼓楼医院:1泌尿外科,2.心胸外科,江苏南京210008)RetrOperitOneallaparoscopycombinedwithopensurgeryforrenalcellcarcinomawithlevel1VvenacavathrombusJIChang-wei,ZHANGGu—tian,WANGQiang。,ZHAOXiao—zhi,LIA
2、NHui—bo,ZHANGShi—wei,GUOHong—qian(1.DepartmentofUrology,2.DepartmentofCardiothoracicSurgery,NanjingDrumTowerHospital,Af—filiatedHospitalofMedicalSchoolofNanjingUniversity,Nanjing210008,China)ABSTRACT:ObjectiveToexploretheefficacyandsafetyofretroperitoneallaparoscopycomb
3、inedwithopensurgeryforrenaleellcarcinomawithlevelIVvenacavathrombus.MethodsClinicaldataof7casesofrenaleellcarcinomaandlevelIVinferiorvenacavathrombustreatedduringFeb.2004toAug.2014wereretrOspectiVelyanalyzed.Cardiopulmonarybypass(CPB)withdeephypothermiccirculatoryarrest
4、(DHCA)wasappliedforthrombectomyinallpatients.Fourpatientsunder—wentsimpleopensurgery,and3patientsunderwentretroperitoneallaparoscopycombinedwithopensurgery.ResultsAlloperationsweretechnicallysuccessfu1.Thetumorandvenacavathrombuswerecompletelyresectedandnoinvasionofthec
5、a—valwallwasobserved.Onepatientdiedofpostoperativebleeding.Comparedwiththeretroperit0nea1laparoscopicgroup,theopensurgerygrouphadmorebloodlossandlongerincisionlength(2737.5VS.850mL,60.5VS.47.7cm,bothP<0.05).Therewasnodifferenceinoperationtime,circulatoryarresttimeandpos
6、toperativeh0spitalizatiOntimebetweenthetwogroups(P>O.05).Duringthefollow—upof4to108months(mean46.3months),2patientsdiedduetolungmetastasisinmonth22and24respectively,and4patientswerealive.ConclusionsRetr0peritoneallaparoscopycombinedwithopensur—gerycouldsignificantlyredu
7、cebloodlossandincisionlength.KEYWoRDS:renalcellcarcinoma;venacavathrombus;deephypothermiccirculatoryarrest;retroperitoneallaparoscopic摘要: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
8、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
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