Robot-assisted laparoscopic retroperitoneal leiomyosarcoma resection with inferior vena cava graft replacement: a case report.
Robot-assisted laparoscopic retroperitoneal leiomyosarcoma resection with inferior vena cava graft replacement: a case report.
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机器人辅助腹腔镜腹膜后平滑肌肉瘤切除术并下腔静脉移植物置换术：病例报告
DOI：
10.21037/tau-20-1523
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发表时间：
2021-05
影响因子：
2
通讯作者：
Zhang X
中科院分区：
文献类型：
--
作者：
Cheng G;Ruan H;Yang C;Cao Q;Liang H;Yang X;Jiang G;Zhang X
本研究的目的是报告机器人辅助腹腔镜下腹膜后平滑肌肉瘤切除术和下腔静脉移植物置换术的初步临床经验。患者为45岁女性，腹痛。她被转诊到我院，发现腹膜后肿块（46 mm × 45 mm）。肿瘤侵犯下腔静脉和左肾静脉远端，MRI可见明显压迫。术前血钾、肾上腺素、去甲肾上腺素、皮质醇、促肾上腺皮质激素、肾素-血管紧张素-醛固酮系统均在正常范围。手术通过六端口机器人辅助经腹膜腹腔镜方法进行。肿瘤被完全切除，下腔静脉粘连部分（约5 cm）被剥离。考虑到大血管的严重损伤，我们决定用延长的聚四氟乙烯移植物替换切除的腔静脉段，并进行下腔静脉重建。患者术后11天出院，移植物中存在栓塞。术后常规抗凝治疗，3个月血栓缩小。腹痛消失，病理检查证实肿瘤为平滑肌肉瘤，边缘阴性，无肿瘤。下腔静脉平滑肌肉瘤是外科医生的一个技术挑战。术前应做好充分的准备，以利于肿瘤切除和血管处理。在特殊情况下，机器人切除平滑肌肉瘤从大血管和血管修复可能是可行的选择，在经验丰富的手。
The aim of the present study was to report the initial clinical experience of robot-assisted laparoscopic retroperitoneal leiomyosarcoma resection with inferior vena cava graft replacement. The patient was a 45-year-old female with abdominal pain. She was referred to our hospital and found to be with a retroperitoneal mass (46 mm × 45 mm). The inferior vena cava and the distal part of left renal vein were invaded by the tumor and compression was obviously seen from magnetic resonance imaging. The serum level of potassium, epinephrine, norepinephrine, cortisol, adrenocorticotropic hormone and renin angiotensin aldosterone system were all in normal ranges before the surgery. The operation was performed via a six port, robot assisted, transperitoneal laparoscopic approach. The tumor was completely resected and adherent part of inferior vena cava (approximately 5 cm) was dissected. Considering severe impairment of the great vessel, we decided to replace excised caval segment with an extended polytetrafluoroethylene graft and undertook the inferior vena cava reconstruction. The patient was discharged 11 days postoperatively with embolus in the graft. Anticoagulants were routinely administrated and the thrombus seemed to be smaller 3 months after operation. Abdominal pain was resolved and pathological examination finally confirmed that the tumor was leiomyosarcoma with negative margins free from tumor. Leiomyosarcoma of inferior vena cava present a technical challenge to surgeons. Comprehensive preparation should be made preoperatively to facilitate tumor resection and vascular management. In specific cases, robotic resection of leiomyosarcoma from great vessels and vascular repairment might be feasible options in experienced hands.
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DOI：
10.1016/j.jvscit.2019.08.005
发表时间：
2019-12-01
影响因子：
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作者：
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