Recently, Mr. Wang, who lives in Hefei, often feels pain in his left lower abdomen. In his prime of life, he did not pay attention to the discomfort of his body at first. After several times of pain, he went to the local hospital under the supervision of his family. The examination results showed that his left kidney had a large tumor, and the tumor had penetrated into the human body's largest blood vessel, the inferior vena cava, and "climbed" along the vein Near the heart. Recently, Mr. Wang received surgical treatment in the Second Affiliated Hospital of Anyi Medical University. With the cooperation and cooperation of multidisciplinary experts in the department of urology, cardiac surgery, hepatobiliary surgery, anesthesiology and other disciplines, the "bomb" was successfully removed.
Tumor sways with the heartbeat, threatening life all the time
According to Zhang Tao, chief physician of urology, the inferior vena cava is the channel through which most of the blood in the lower limbs, abdomen and other veins of the human body flows back to the heart, with large blood flow. Once the tumor thrombus in the inferior vena cava falls off, it can lead to fatal pulmonary embolism at any time, leading to sudden death of patients. Zhang Tao said that for renal cancer without multiple metastasis, radical nephrectomy and removal of tumor thrombus in inferior vena cava is the most effective treatment. However, the anatomical relationship of this operation is complex, involving the blocking and reconstruction of multiple organs such as kidney, liver, vena cava, renal vein, heart, etc. During the operation, serious complications such as massive bleeding, tumor thrombus shedding, and pulmonary embolism may occur, which is difficult and risky.
Multiple departments worked together to remove the "time bomb"
In order to ensure the smooth implementation of the operation, doctors, based on preoperative abdominal CT, magnetic resonance, cardiac ultrasound and other imaging data, through consultation and discussion with experts from urology, hepatobiliary surgery, cardiac surgery, anesthesia department, blood transfusion department and other departments, carefully evaluated the scope of the tumor thrombus in the inferior vena cava, and the relationship between the top of the tumor thrombus and the diaphragm and the right atrium, The distal blood vessels of the tumor thrombus and the lymph around the left renal hilum. After full communication, Mr. Wang finally chose to accept radical resection of left renal cell carcinoma+removal of tumor thrombus in inferior vena cava. Before the operation, the doctor worked out a three-step operation plan for him, including the inferior vena cava incision and thrombectomy under the monitoring of esophageal ultrasound, radical left kidney resection, and lymph node dissection at the hilum of the kidney and the abdominal aorta. At the same time, emergency plans have been formulated, such as tumor thrombus falling off during operation, and timely extracorporeal bypass atrial or pulmonary artery incision for thrombus removal.
On the day of operation, Yu Dexin, chief physician of Urology Department of the Second Affiliated Hospital of Anyi Medical University, and Zhang Tao, chief physician of Hepatobiliary Surgery Department, Lu Zhong, chief physician of Heart Surgery Department, as well as the anesthesia department and the operating room team, acted as the chief surgeon, and the operation was carried out in an orderly manner. The operation took more than 4 hours to complete successfully, successfully "removing" the "time bomb" in Mr. Wang's body.
Renal carcinoma complicated with high vena cava tumor thrombus is not a restricted area for surgery
After the operation, Mr. Wang's vital signs were stable, and he returned to the urological surgery ward the next day after ICU monitoring. The liver and kidney functions were monitored to be good, and he had recovered recently and was about to leave the hospital.
Chief physician Zhang Tao reminded that renal cancer is one of the common tumors of the urinary system, which often has no obvious symptoms in its early stage. Hematuria caused by renal tumors mostly occurs in the middle and late stages, and is often intermittent attacks, or even "natural improvement". Moreover, this kind of hematuria often has no pain, so it is easy to be ignored by patients. The majority of early renal cancer can be cured by preserving part of the kidney through surgery.
For renal cancer with high vena cava tumor thrombus, multidisciplinary cooperation and esophageal ultrasound detection improve the safety of surgery, which is conducive to timely treatment of tumor thrombus shedding during surgery. The application of transabdominal pericardial whole liver blood flow occlusion technique in the removal of tumor thrombus from high vena cava reduces the trauma of high thoracic vena cava occlusion. Therefore, experts suggest that renal cancer with high vena cava tumor thrombus is not a restricted area for surgery. At the same time, experts remind that regular physical examination is essential for the detection of early renal tumors. Urinary ultrasound can be used as an option for routine physical examination. In particular, painless gross hematuria should be paid enough attention to and early treatment should be given to prevent delay in the condition. (Ma Jiaxing, Dai Rui)
(Editor in charge: Huang Yan, Zhang Lei)
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