Prosthetic replacement of the inferior vena cava and the iliofemoral vein for urologically related malignancies
Prosthetic replacement of the inferior vena cava and the iliofemoral vein for urologically related malignancies
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DOI：
10.1046/j.1464-410x.2002.02919.x
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发表时间：
2002-09-01
影响因子：
4.5
通讯作者：
Minervini, R
中科院分区：
文献类型：
--
作者：
Caldarelli, G;Minervini, A;Minervini, R
目的探讨人工静脉置换术的可行性及效果。由于下腔静脉（IVC）和髂股静脉广泛累及肾细胞癌（RCC）或其他泌尿系恶性肿瘤的大而固定的癌栓，有时需要切除和置换。患者和方法五名男性和两名女性（年龄范围41-75岁）在10年期间（1991-2001年）通过积极的静脉手术进行治疗，以实现完全肿瘤切除，并进行人工移植物置换以重建静脉血流。肿瘤包括右肾肾细胞癌（2例）、腹膜后脂肪肉瘤（2例）、膀胱癌（1例）、腹膜后纤维肉瘤（1例）和腹股沟盆腔淋巴瘤（1例）。2例患者接受了腔静脉置换术，其中1例使用了环形增强PTFE，1例使用了涤纶银移植物; 5例患者使用了髂股或髂髂环形增强PTFE移植物。下腔静脉移植物的假体直径为18-20 mm，髂动脉移植物的假体直径为8-10 mm。在所有患者中，移植物通畅性进行了评估，在后续的彩色血流多普勒成像，并在一个，它是由血管计算机断层扫描和venography.Results术后30天死亡的一名患者，其余6例患者没有证据表明，在12个月的区域复发或转移性疾病，5例死于肿瘤复发8-30个月后手术。平均死亡时间为23个月。在3个月，所有6个假体是专利，在6个月4专利，在12个月3的5个假体patent.Conclusion切除和更换下腔静脉允许完整的肿瘤切除，避免肾功能衰竭，提供持久的缓解静脉阻塞的症状。髂股动脉假体重建治疗泌尿系统相关恶性肿瘤是避免静脉充血和下肢肿胀的可行选择，至少在术后早期是如此。目前患者的平均死亡时间必须被认为是这些积极手术的极限。
Objective To evaluate the feasibility and results of prosthetic venous replacement, as inferior vena cava (IVC) and iliofemoral vein resection and replacement are sometimes necessary when they are extensively involved by a large and fixed tumour thrombus from renal cell carcinoma (RCC) or other urological malignancies.Patients and methods Five men and two women (age range 41-75 years) were treated over a 10-year period (1991-2001) by aggressive venous surgery to achieve complete tumour resection, with prosthetic graft replacement to re-establish venous flow. The tumours included RCC of the right kidney (two), retroperitoneal liposarcoma (two), bladder cancer (one), retroperitoneal fibrosarcoma (one) and inguino-pelvic lymphoma (one). Two patients had a vena caval replacement, of whom one had a circular reinforced PTFE and one a Dacron silver graft; five patients had either an iliofemoral or an ilio-iliac circular reinforced PTFE graft. The prosthetic diameter was 18-20 mm for the IVC grafts and 8-10 mm for the iliac grafts. In all the patients, graft patency was evaluated during the follow-up by colour flow duplex imaging, and in one it was determined by angio-computed tomography scan and venography.Results One patient died 30 days after surgery; of the remaining six patients one had no evidence of regional recurrence or metastatic disease at 12 months, and five died from recurrent tumour 8-30 months after surgery. The mean time to death was 23 months. At 3 months all six prosthesis were patent; at 6 months four were patent and at 12 months three of five prostheses were patent.Conclusion Resecting and replacing the IVC allows complete tumour resection and avoids renal failure, providing durable relief from the symptoms of venous obstruction. Iliofemoral prosthetic reconstruction for urological-related malignancies represents a viable option to avoid venous engorgement and lower extremity swelling, at least in the early postoperative period. The mean time to death for the present patients must be considered the limit for these aggressive operations.