探索肾部分切除术治疗肾癌合并肾静脉癌栓的可能性。

回顾性分析2018年1月至2021年12月同一术者进行的因肾脏恶性肿瘤行腹腔镜肾部分切除术的病例，其中6例患者伴有肾静脉癌栓，男性4例，女性2例，3例肿瘤位于左肾，3例位于右肾。

肿瘤直径1.8～3.5 cm。5例保肾成功，1例患者因癌栓充满肾静脉主干，且距离肿瘤较远，中转肾癌根治术，1例孤立肾患者，予以术中冰水降温。手术时间129～195 min，热缺血时间24～32 min，术中出血量100～200 ml，5例保肾成功的患者切缘均未见肿瘤残余，1例患者术后出现轻度血尿，予以膀胱持续冲洗后好转。所有患者病理均提示肾透明细胞癌，经18～51个月的随访，未见肿瘤复发。

对于高选择性的肾癌伴肾静脉癌栓的患者，腹腔镜肾部分切除术可能是一种新的可选治疗方式，但由于目前数据有限，尚无法确切评估其安全性和有效性，肾癌根治术依然是此类患者的标准治疗术式。

To explore the possibility of partial nephrectomy in the treatment of renal cancer with renal vein tumor thrombus.

From January 2018 to December 2021, laparoscopic partial nephrectomy was carried out in Shanghai Changhai Hospital for renal malignant tumors. Six of these patients had renal cell carcinoma with renal vein tumor thrombus. Four were males and 2 were females. Three tumors located in the left kidney and 3 in the right kidney.

The tumor was 1.8-3.5 cm in diameter. Five patients were successful in sparing the kidney. In one case, the renal vein was full of thrombus and the distance from the tumor to thrombus was far away. Therefore, the surgery was converted to radical nephrectomy. In one patient with solitary kidney, iced water was applied during surgery. The operation time was 129-195 min, the warm ischemia time was 24-32 min, and the intraoperative bleeding volume was 100-200 ml. No positive margin was detected in the patients with successfully kidney sparing. One patient had mild hematuria after operation, and it was improved by continuous bladder irragation. Renal clear cell carcinoma was diagnosed in all patients, and no recurrence occured after 18 to 51 months of follow-up.

Laparoscopic partial nephrectomy may be a new alternative treatment for highly selective patients with renal cell carcinoma and renal vein tumor thrombus. However, due to the limited data at present, the safety and effectiveness of laparoscopic partial nephrectomy can not be evaluated accurately. Radical nephrectomy is still the standard treatment for such patients.