机器人辅助腹腔镜治疗肾错构瘤合并下腔静脉瘤栓两例报道并文献复习

doi:10.3877/cma.j.issn.1674-3253.2024.05.009

目的

报道机器人辅助腹腔镜手术治疗肾错构瘤伴下腔静脉瘤栓的临床效果并复习肾错构瘤伴下腔静脉瘤栓的临床诊疗进展。

方法

分析2021年3月至10月就诊于安徽医科大学第一附属医院泌尿外科两例肾错构瘤伴下腔静脉瘤栓患者的临床资料，结合相关文献进行复习、总结。

结果

两例患者，男女各1例，年龄分别为39和57岁，肿瘤均位于右侧。其中男性患者肿瘤大小为15.0 cm×10.0 cm×9.0 cm，瘤栓Mayo分级Ⅱ级；女性患者肿瘤大小为6.0 cm×4.8 cm×4.5 cm，瘤栓Mayo分级Ⅱ级。均行机器人辅助腹腔镜下右肾根治性切除术+下腔静脉切开取栓术，手术均顺利完成，无中转开腹，两例患者围手术期无并发症发生，术后病理提示均为肾错构瘤伴下腔静脉瘤栓，其中两例病例均随访12个月，未见肿瘤复发或转移。

结论

肾错构瘤合并下腔静脉瘤栓的病例临床较为罕见，需行外科手术治疗，术后一般预后较好，而且机器人辅助腹腔镜的方式对于治疗肾错构瘤合并Mayo Ⅱ级下腔静脉瘤栓可行性良好。

关键词: 肾错构瘤, 下腔静脉, 瘤栓, 机器人辅助腹腔镜

Objective

To report the effect of the clinical treatment of the renal angiomyolipoma with inferior vena cava tumor thrombus through Robot-assisted laparoscopic radical nephrectomy, then review the clinical progress in diagnosis and treatment of renal angiomyolipoma with inferior vena cava tumor.

Methods

The clinical data of the patients who were treated in the First Affiliated Hospital of AnHui Medical University from March 2021 to October 2021 was analyzed and a summary with relevant literature was made.

Results

One case was a 39 year old male and the other case was a 57 year old female, both patients’ tumors were on the right side. The size of the tumor of the male patient was 15.0 cm×10.0 cm×9.0 cm with Mayo grade Ⅱ inferior vena cava tumor thrombus. The size of the tumor of the other patient was 6.0 cm×4.8 cm×4.5cm with Mayo grade Ⅱ inferior vena cava tumor thrombus. Both of 2 cases underwent robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy. The operation was successful in the group without conversion to laparotomy and no complications occured during the perioperative period. Postoperative pathology proved renal angiomyolipoma with inferior vena cava thrombus. After 12 months and 3 months of follow-up, both of patients did not have relapse and transfer.

Conclusions

The case of renal angiomyolipoma with inferior vena cava tumor thrombus is rare in clinic which is in great need of surgical treatment, and the postoperative prognosis is normally positive. The cases we reported prove the feasibility of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy in treating renal angiomyolipoma with Mayo grade Ⅱ inferior vena cava tumor thrombus.

Key words: Renal angiomyolipoma, Inferior vena cava, Tumor thrombus, Robot-assisted laparoscopic

图1 肾错构瘤合并下腔静脉瘤栓病例影像和病理资料注：图1a、1b为病例1患者术前CT检查，1a、1b箭头指肾错构瘤瘤栓延肾静脉侵及下腔静脉；1c为病例1患者术后病理（HE染色×100）示肾血管平滑肌脂肪瘤及下腔静脉瘤栓，同时肿瘤旁肾实质小灶可见肾小球纤维化伴间质慢性炎细胞浸润；1d为病例1患者术后11个月复查CT提示右肾切除后，未见肿瘤复发或转移；图1e、1f为病例2术前提示肾错构瘤伴下腔静脉瘤栓，箭头指肾错构瘤栓子侵及下腔静脉后形成下腔静脉瘤栓，可见瘤栓分为两部分，且极易脱落；1g为病例2患者术后瘤栓大体标本，可见瘤栓分为两部分，之间仅以纤细的蒂相连接，1h为病例2患者术后病理（HE染色×100）示肾血管平滑肌脂肪瘤及下腔静脉瘤栓，肿瘤旁肾实质可见肾小球纤维化，间质小灶见间质慢性炎细胞浸润；1i为病例2患者术后三个月复查CT可见右肾切除后改变，未见肿瘤复发或转移

图2 机器人辅助腹腔镜下右肾根治术+下腔静脉切开取栓术手术套管放置示意图和术中关键步骤注：2a为术前使用球囊阻断，黑色箭头所指即于下腔静脉近心端放置的球囊导管，有效防止术中血栓脱落导致致死性肺栓塞；2b为手术套管放置示意图；2c为术中使用直线型切割吻合器离断肝短静脉；2d为术中超声定位瘤栓；2e为术中所见，黑色箭头所指即为下腔静脉瘤栓，金黄色，质软，富含脂肪易碎裂，且与静脉壁无粘连，表面光滑易脱落

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Robot-assisted laparoscopic radical nephrectomy for renal angiomyolipoma with inferior vena cava tumor thrombus: two cases report and literature review

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Robot-assisted laparoscopic radical nephrectomy for renal angiomyolipoma with inferior vena cava tumor thrombus: two cases report and literature review