RESUMEN
Retrospective investigation, conducted for estimation of perioperative complications, while performing surgical treatment of a renalcell cancer with tumoral thrombi, was presented. In 132 patients the tumoral thrombi spreading is restricted by renal vein and by vena cava inferior (VCI) as well. The patients were operated on, using the "chevron" access in the absence of artificial blood circulation. Perioperative complications rate in the patients in presence of macroscopic tumoral thrombi constitute 56.8%, while tumoral spreading into VCI is trustworthy bigger (Ñ<0.05). Presence of cardiac insufficiency, tumoral invasion of the VCI wall, retrograde spreading of thrombus with the VCI concurrent blood thrombosis, аs well as presence of the indices in accordance to the ECOG scale more than 1 point have constituted unfavorable factors.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Complicaciones Posoperatorias/patología , Trombectomía/métodos , Trombosis de la Vena/cirugía , Edema Encefálico/etiología , Edema Encefálico/mortalidad , Edema Encefálico/patología , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/mortalidad , Trastornos Cerebrovasculares/patología , Humanos , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Invasividad Neoplásica , Células Neoplásicas Circulantes/patología , Nefrectomía/métodos , Complicaciones Posoperatorias/mortalidad , Venas Renales/patología , Venas Renales/cirugía , Estudios Retrospectivos , Análisis de Supervivencia , Vena Cava Inferior/patología , Vena Cava Inferior/cirugía , Trombosis de la Vena/mortalidad , Trombosis de la Vena/patologíaRESUMEN
The analysis of the effectiveness of a new method of thrombectomy, including the formation of cross-tunnel under the ostium of the main hepatic veins by removing tumor thrombus of the inferior vena cava (IVC). Successfully perform a piggy back manage to mobilize the liver in 12 (80%) patients, a tunnel formed in 4 (50%). Duration pigg back stage liver mobilization much higher than the formation of the tunnel. Forming tunnel cross recommended conditions when the IVC portion covered retrohepatic liver less than 1/2 of a circle or when the surgeon is sure to Derform manipulation capabilities.
Asunto(s)
Venas Hepáticas/cirugía , Neoplasias Hepáticas/cirugía , Derivación Portocava Quirúrgica/métodos , Vena Porta/cirugía , Trombosis/cirugía , Vena Cava Inferior/cirugía , Venas Hepáticas/patología , Humanos , Hígado/irrigación sanguínea , Hígado/patología , Hígado/cirugía , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/patología , Metástasis de la Neoplasia , Vena Porta/patología , Trombectomía/métodos , Trombosis/etiología , Trombosis/patología , Factores de Tiempo , Vena Cava Inferior/patologíaRESUMEN
Efficacy and safety of a renal artery ligation after thrombectomy in comparison with those while using a standard surgical technique were studied. Possibility of performance and safety of thrombectomy without preliminary ligation of renal artery was proved. The results did not depend on level of intravenous tumoral spread and were significantly better, than while application of standard approaches to renal artery because of absence of embolic complications.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Riñón/cirugía , Arteria Renal/cirugía , Trombosis/cirugía , Vena Cava Inferior/cirugía , Anciano , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/patología , Embolia Aérea/prevención & control , Femenino , Humanos , Riñón/irrigación sanguínea , Riñón/patología , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/patología , Ligadura , Masculino , Persona de Mediana Edad , Nefrectomía , Arteria Renal/patología , Trombectomía/métodos , Trombosis/patología , Vena Cava Inferior/patologíaRESUMEN
Safety and possibility to perform abdominal surgical accesses to supradiaphragmatic part of vena cava inferior (VCI) in patients, operated on for renal-cell cancer, were estimated. In 12 patients the results of application of several surgical access variants to supradiaphragmatic part of VCI were estimated. Most simple and safe way to isolate supradiaphragmatic VCI and cavaatrial junction is to perform a T-like diaphragmotomy. Intraoperative complications rate have constituted 36.4%. The blood loss volume due to VCI injury (in 3 cases) while performing transdiaphragmatic surgical access to supradiaphragmatic part of VCI, have constituted 112.5 ml at average. Injuries of pleura, pericardium, main truncus of diaphragmatic nerve did not occur.
Asunto(s)
Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Embolia Pulmonar/patología , Cavidad Abdominal/cirugía , Adulto , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/patología , Diafragma/cirugía , Femenino , Humanos , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Pericardio , Vena Cava Inferior/cirugíaRESUMEN
The paper analyzes surgical methods of bleeding control from the lumen of the isolated inferior vena cava (IVC) segment during thrombectomy. The study included 13 patients with IVC tumor thrombus. The sources of bleeding were divided into variant lumbar veins and lumbar veins of the infrarenal IVC segment. Variant lumbar veins were classified as vessels entering IVC at its posterior surface at suprarenal level. The volume of blood loss from the lumen of the isolated IVC segment during thrombectomy ranged from 100 to 3500 ml with an average of 507.3 ml. The main sources of bleeding were lumbar veins of the infrarenal IVC segment, located at a distance of less than 10 mm from the mouth of the right renal vein (85.7%). Variant veins were found much rarer--in 35.7% of cases. Their orifice diameter and, consequently, the blood loss volume was significantly smaller than those in the group of bleeding from infrarenal lumbar vessels. In 2 (15.4%) cases, the mouths of the venous tributaries were stitched inside the vena cava. In 6 (46.2%) patients the bleeding was stopped by applying a clamp to lumbar veins following the blood clot removal. This maneuver proved successful in 4 (66.7%) of those cases. In the remaining 5 (38.5%) cases, the bleeding was stopped by compression of probable variant or lumbar vein mouth localization with finger or cotton swab. If unable to stop bleeding in the described way, the blood from IVC lumen was evacuated by suction, and cavatomy was closed as quickly as possible. Given the low effectiveness, high complexity and risk of the available methods of IVC lumen bleeding control, visual information about the location and the number of possible sources of bleeding should be obtained preoperatively.