Безопасность перевязки левой почечной вены во время циркулярной резекции нижней полой вены у больных раком правой почки с опухолевым венозным тромбозом
Безопасность перевязки левой почечной вены во время циркулярной резекции нижней полой вены у больных раком правой почки с опухолевым венозным тромбозом
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Безопасность перевязки левой почечной вены во время циркулярной резекции нижней полой вены у больных раком правой ки с опухолевым венозным тромбозом
DOI：
10.17650/1726-9776-2018-14-4-30-36
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Владимир Борисович Матвеев
中科院分区：
文献类型：
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作者：
Мария Игоревна Волкова;В. А. Черняев;А. К. Бегалиев;А. В. Климов;Владимир Борисович Матвеев
目的：目的探讨右肾癌伴肿瘤静脉血栓患者行下腔静脉环形切除术时左肾静脉结扎的安全性。材料和方法。我们选择了63例接受肾切除术、血栓切除术、下腔静脉切除术并LRV结扎（第1组; n = 29（46.0%））或保留对侧肾静脉流出（第2组; n = 34（54.0%））的肿瘤静脉侵犯的肾细胞癌患者的医疗数据。研究参与者的中位年龄为56.0 ± 8.8岁（范围：32-72岁）;男女比例为1：1.9。年龄、性别、肾小球滤过率（GFR）中位数、慢性肾脏病（CKD）分期、失血量和手术持续时间等参数在两组之间具有可比性（所有参数均>0.05）。中位随访时间为32.8个月（范围：1-226个月）。结果我们观察到，与基线相比，结扎LRV患者（65.7 vs 71.2 mL/min/1.73 m2; р >0.05）和保留对侧肾静脉流出的患者（60.6 vs 68.4 mL/min/1.73 m2; р >0.5）的中位GFR在术后后期没有显著变化。与对侧肾静脉流出正常的患者相比，接受LRV结扎的患者GFR降低的可能性较小（34.5% vs 44.1%; p >0.05）。然而，LRV结扎受试者的CKD分期（从0-I期到I-II期）比静脉流出保留受试者更频繁（27.6% vs 5.9%; р = 0.022）。LRV结扎后无患者发生III期CKD。结论在伴有肿瘤静脉血栓形成的右侧肾细胞癌患者的IVC环形切除术中，LRV结扎不会导致肾功能长期恶化的临床显著减少。
Objective : to assess safety of left renal vein (LRV) ligation during circular resection of the inferior vena cava in right-side kidney carcinoma with tumor venous thrombosis. Materials and methods . We selected medical data of 63 renal cell carcinoma patients with tumor venous invasion undergone nephrectomy, thrombectomy, IVC resection with LRV ligation (Group 1; n = 29 (46.0 %)) or preservation of venous outflow from the contralateral kidney (Group 2; n = 34 (54.0 %)). Median age of study participants was 56.0 + 8.8 years (range: 32—72 years); a male to female ratio was 1:1.9. Such parameters as age, gender, median glomerular filtration rate (GFR), stages of chronic kidney disease (CKD), blood loss, and duration of surgery were comparable across the two groups ( р >0.05 for all parameters). Median follow-up was 32.8 months (range: 1—226 months). Results. We observed no significant changes in median GFR in the late postoperative period compared to baseline among patients with ligated LRV (65.7 vs 71.2 mL/min/1.73 m2; р >0.05) and patients with preserved venous outflow from the contralateral kidney (60.6 vs 68.4 mL/min/1.73 m2; р >0.5). Patients that underwent LRV ligation were less likely to have reduced GFR compared to those with normal contralateral renal venous outflow (34.5 % vs 44.1 %; p >0.05). However, participants with ligated LRV had CKD upstaging (from stage 0—I to stage I—II) more frequently than participants with preserved venous outflow (27.6 % vs 5.9 %; р = 0.022). None of the patients developed stage III CKD after LRV ligation. Conclusion . LRV ligation during circular resection of the IVC in right-side renal cell carcinoma patients with tumor venous thrombosis does not lead to a clinically significant decrease in long-term deterioration of renal function.