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中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 459 -462. doi: 10.3877/cma.j.issn.1674-3253.2022.05.019

综述

肾癌合并静脉癌栓的诊疗进展
努尔艾力·排尔哈提1, 展昭兴1, 王令令1, 张古田2, 朱新胜1,()   
  1. 1. 844000 新疆喀什地区第二人民医院泌尿外科
    2. 210008 南京大学医学院附属鼓楼医院泌尿外科
  • 收稿日期:2021-03-16 出版日期:2022-10-01
  • 通信作者: 朱新胜

Progress in the diagnosis and treatment of renal cancer with venous tumor thrombus

Pai Hati Nur Aili·1, Zhaoxing Zhan1, Lingling Wang1   

  • Received:2021-03-16 Published:2022-10-01
引用本文:

努尔艾力·排尔哈提, 展昭兴, 王令令, 张古田, 朱新胜. 肾癌合并静脉癌栓的诊疗进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(05): 459-462.

Pai Hati Nur Aili·, Zhaoxing Zhan, Lingling Wang. Progress in the diagnosis and treatment of renal cancer with venous tumor thrombus[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 459-462.

局部晚期肾癌的一个生物学特质是在肿瘤进展过程中容易侵犯静脉系统,形成癌栓[1]。肾癌合并静脉癌栓的发生率为4%~10%,约1%病例的癌栓可达膈肌以上下腔静脉和右心房水平[2]。静脉癌栓可见于多数肾癌病理类型,癌栓的形成与肿瘤大小、分期和Fuhrman分级密切相关[3]。既往肾癌合并静脉癌栓一直被认为是"手术禁区",因为根治性肾切除术联合静脉癌栓取出术的手术难度大、风险高,术中容易出现大出血,癌栓和(或)血栓脱落导致肺栓塞等严重并发症引起死亡[4]。因此,绝大多数患者被迫采取保守治疗措施,但是预后极差,中位生存时间为5个月,1年肿瘤特异性生存率约29%,往往在短期内死亡[5]。近年来随着手术器械和技术的不断发展,根治性肾切除术联合静脉癌栓取出术已被证实能够明显改善患者的预后和延长生存时间。无淋巴结或远处转移的肾癌合并静脉癌栓患者经手术治疗能够获得治愈,术后5年肿瘤特异性生存率高达40%~65%[6]。同时,多靶点酪氨酸激酶抑制剂(TKI)及哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂等新型分子靶向药物术前可能缩小原发肿瘤病灶及静脉癌栓,降低癌栓分级和肿瘤分期,从而降低手术难度和相关风险[7]。但是,该领域内各类文献报道了不同的研究结果。因此,我们希望通过利用Pubmed、知网等权威数据库,广泛阅读近年来在国内外杂志上发表的有关肾癌合并静脉癌栓的主流研究文献,以综述的方式介绍该领域临床诊疗的最新进展。

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