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腹膜后肿瘤手术并下腔静脉及肾静脉切除与重建 |
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董茂盛 梁发启 宋少柏 蒋彦永
【摘要】 目的 探讨复杂腹膜后肿瘤手术切除时对腹腔大血管的处理方法，以提高肿瘤切
除率。方法 总结了1990年～1997年手术切除腹膜后肿瘤219例中的11例合并下腔静脉（IVC）
或肾静脉（RV）切除的经验。其中RV下IVC切除5例，肝下IVC及右肾切除3例，肝下RV上IVC切
除1例，左RV大部切除与左输卵管静脉吻合2例（1例合并IVC切除）。结果 随访半年本组无1
例死亡，血尿素氮、肌酐及肾脏B超检查均在正常范围。结论 (1)左RV有较多属支和恒定吻
合干与周围静脉相连，可于左RV近心端结扎，如需切除部份RV，则至少保留一个RV属支（通
常为左性腺静脉）以维持循环；(2)IVC切除一般不需行血管重建，但如肾静脉血流受阻，则
应行血管重建，至少保证一个肾脏血液回流。
【关键词】 腹膜后肿瘤 血管外科手术 腔静脉，下
Resection and reconstruction of inferior vena cava and renal vein in surgical treatment of retroperitoneal
tumours: a report of 11 cases Dong Maosheng, Liang Faqi, Song Shaobai,et al.Department of Surgery,
General Hospital of People′s Liberation Army,Beijing 100853.
【Abstract】 Objective To improve the surgical resection rate of complicated retroperitoneal tumors
which depends on handling of celiac major blood vessel.Methods 219 retroperitoneal tumours were
resected from 1990 to 1997. Eleven of them were resected in combination of resections and reconstructi
ons of inferior vena cavas (IVC) and renal veins (RV).IVC below RV was resected in 5 cases, IVC
below liver with resections of right kidney in 3 cases, IVC above RV in 1 case, major partial resections
of left RV with anastomosis to left ovarian vein in 2 cases, and 1 of them with IVC resection.Results
Follow-up showed transient bilateral lower limbs edema in 3 cases.The values of blood urea nitrogen and
creatinine were normal after operations, no changes were found in the kidneys under ultrosonic examinat
ion.Conclusion As the left renal vein has many branches and constant anastomotic branches that connect
with peripheral veins, it can be ligated proximally; and it even can be resected when at least one of its
branches (rountinely lift sexual gland vein) can be kept to maitain the blood circulation. Reconstructio
n of IVC and RV is usually[1] [2] 下一页
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