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[目的]探讨肾细胞癌伴下腔静脉癌栓的诊治方法。[方法]对7例肾细胞癌伴下腔静脉癌栓的资料进行分析,并结合文献讨论。[结果]7例经磁共振成像均确定癌栓范围,其中6例肝下型(Ⅱ型),1例肾静脉型(Ⅰ型)。全部手术取出癌栓,且经病理证实,1例术后20个月死于肺转移,6例随访5～40个月,无瘤存活。[结论]磁共振成像是术前确定癌栓范围的最好方法。没有局部淋巴结侵犯或远处转移的肾癌病人,根治性手术仍是提高肾细胞癌生存率的关键。手术方法的选择取决于癌栓伸入腔静脉的水平和是否侵犯腔静脉壁。
[Objective] To investigate the diagnosis and treatment of renal cell carcinoma with inferior vena cava tumor thrombus. [Method] The data of 7 cases of renal cell carcinoma with IVC tumor thrombus were analyzed and discussed in the literature. [Results] The scope of tumor embolism was confirmed by magnetic resonance imaging in all 7 cases, including 6 cases of subhepatic type (type Ⅱ) and 1 case of renal vein type (type Ⅰ). Tumor thrombus was removed in all surgeries, and confirmed by pathology. One patient died of lung metastasis 20 months after operation, and 6 patients were followed up for 5 to 40 months. [Conclusion] MRI is the best method to determine the scope of tumor thrombus before operation. Radical surgery is still the key to improve the survival rate of renal cell carcinoma without renal lymph node invasion or distant metastasis of patients. The choice of surgical procedure depends on the extent to which the thrombus extends into the vena cava and infiltrates the wall of the vena cava.