不同分级肾静脉瘤栓后腹腔镜左肾癌根治术的可行性

目的：探讨左肾癌伴有不同分级肾静脉瘤栓患者经后腹腔途径腹腔镜左肾癌根治术的可行性。方法：7例左肾占位伴左肾静脉瘤栓患者，增强CT显示7例肿物不均匀强化，并伴有。肾静脉内充盈缺损，均在全麻下行后腹腔镜左肾癌根治术。术中放置4个穿刺套管针，游离腹主动脉和肾动脉后，Hem-o-lok结扎切断。肾动脉，游离肾静脉后判断7例瘤栓均为非附壁瘤栓，上托肾脏，于肾静脉近下腔静脉处Hem—O—lok结扎切断。肾静脉，完整切除肾脏及瘤栓。我们根据左。肾静脉瘤栓长度进行分级，讨论不同分级患者手术难点及可行性。结果：7例手术均获成功，术后恢复良好。病理诊断为肾透明细胞癌6例，嫌色细胞癌1例。术后随访8个月（1～18个月），未见肿瘤复发和转移。结论：对于选择性病例伴有不同分级的肾静脉瘤栓的左肾癌行经后腹腔途径腹腔镜左肾癌根治术可行，但随瘤栓分级增加手术难度增大。

Laparoscopic Radical Nephrectomy Using a Retroperitoneal Approach for Left Renal Carcinoma with Different Grade of Renal Vein Tumor Thrombus

Objective：To evaluate the leaslblllty ot laparoscoplc raulcal nepmectumy usingaretroperitoneal proach for left renal carcinoma with different grade of renal vein tumor thrombus. Methods： Seven cases of left renal tumor with renal vein tumor thrombus were reported. Contrast-enhanced CT showed filling defects in left renal vein in all patients. All patients received laparoscopic radical nephrectomy using a retroperitoneal approach. Four trocars were placed during operation, and the renal vein was dissected after the renal artery was mobilized and dissected, Hem-o-lok was used to dissect the renal vein. According to our classification of the left renal vein tumor thromhus, grade 1 in 2 patient, grade 2 in 1,grade 3 in 3 and grade 4 in 1. Results：All operations were performed successfully without open conversion. Pathologically, tumors were confirmed to be renal clear cell carcinoma in 6 patients and renal chromophobe carcinoma in 1 patient. No tumor recurrence or metastasis occurred with follow-up of 8 months（1-18 months）. Conclusions： Laparoscopic radical nephrectomy using a retroperitoneal approach for left renal carcinoma with different grade of renal vein tumor thrombus is feasible in carefully selected patients. However, surgery will be more difficult with the grade of tumor thrombus increases.