后腹腔镜联合开放治疗肾癌Ⅳ级下腔静脉瘤栓-论文.pdf

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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