科研之友
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摘要
Introduction: Techniques for the resection of renal tumours (RI) with extension to the inferior vena cava (IVC) are based on the experience of individual units. We attempt to provide a logical approach to the surgical strategies in a stepwise fashion.
Methods: Over 6 years, 9 patients with RT invading the IVC underwent surgery. There were 6 males. The extension was at level IV in 3 and III in 6 cases. Cardiopulmonary bypass was used in 7 and hypothermia and circulatory arrest in 2 patients with level IV disease. The results and an algorithm of the plan of action in relation to the level of extension are presented.
Results: Regarding postoperative morbidity, inotropic support was needed in 5 patients, a prolonged ICU stay in 3 (33.3%), tracheostomy in 1(11.1%). Methicillin-resistant Staphylococcus aureus infection occurred in 1, sepsis in 2, cerebrovascular accident in 1. There were 2 deaths (22.2%). For level I-II disease there was no cardiothoracic involvement. For level III we used cardiopulmonary bypass and control of the cavo-atrial junction. For level IV or suboptimal thrombectomy of level III disease, we used brief periods of circulatory arrest and repair of the cavotomy with a pericardial patch.
Conclusions: Total clearance of the IVC from an adherent tumour is important for prognosis, therefore extensive level III and IV disease presents a surgical challenge. We recommend cardiopulmonary bypass for level III and brief periods of total circulatory arrest for level IV disease.
- 出版日期2011-6
