中文摘要：

目的探讨肿瘤累及肾上段下腔静脉的手术治疗。方法回顾性分析2007年1月至2015年5月第二军医大学附属长海医院收治的35例累及肾上段下腔静脉肿瘤患者的临床资料。所有患者术前行影像学检查，明确肾上段下腔静脉受累部位和范围。肿瘤类别：肾癌下腔静脉癌栓19例，下腔静脉平滑肌肉瘤5例，下腔静脉平滑肌瘤病3例，肾上腺皮质癌下腔静脉癌栓3例，肝癌下腔静脉癌栓2例，右侧肾上腺嗜铬细胞瘤2例，腹膜后纤维肉瘤下腔静脉癌栓1例。依据肿瘤累及类型，选择不同的手术入路、下腔静脉阻断平面及方法、重建方式、预防癌栓脱落的方法。采用门诊和电话方式进行随访，随访时间截至2015年5月。结果19例肾癌下腔静脉癌栓患者中，10例在术前经颈内静脉放置了下腔静脉滤器；10例行全肝血流阻断，9例行肝下下腔静脉阻断；19例均行肿瘤切除，下腔静脉切开取栓缝合。5例下腔静脉平滑肌肉瘤患者中，3例行全肝血流阻断，2例行肝下下腔静脉阻断；5例患者均切除病变段下腔静脉，其中4例行人工血管重建，1例合并右肾切除者单纯结扎肿瘤近端和远端下腔静脉和左肾静脉。3例下腔静脉平滑肌瘤病患者中，2例行全肝血流阻断，1例在体外循环下手术；3例患者均行下腔静脉切开取栓缝合，并同时行子宫切除。3例肾上腺皮质癌下腔静脉癌栓患者和2例肝癌下腔静脉癌栓患者均行全肝血流阻断；5例患者中，4例行肿瘤切除联合下腔静脉部分切除直接缝合，1例行下腔静脉部分切除后补片成形。2例右侧肾上腺嗜铬细胞瘤患者术中显露下腔静脉近、远端后悬吊，未阻断；均完整将肿瘤从下腔静脉剥离。1例腹膜后纤维肉瘤下腔静脉癌栓患者，拟行肝下下腔静脉阻断，但术中发生癌栓脱落肺栓塞，患者死亡。35例患者中，34例顺利完成手术，1例围术期死亡

英文摘要：

Objective To investigate surgical treatment for tumor involved inferior vena cava at the upper segment of kidney. Methods The clinical data of 35 patients with tumor involved inferior vena cava at the upper segment of kidney who were admitted to Changhai Hospital affiliated to the Second Military Medical University from January 2007 to May 2015 were retrospectively analyzed. All the patients received preoperative imaging examinations to insure the site and range of inferior vena cava involvement at the upper segment of kidney. Renal cell carcinomas with inferior vena cava involvement were found in 19 cases, leiomyosarcomas of inferior vena cava in 5 cases, leiomyomatosis involving inferior vena cava in 3 cases, adrenocortical carcinoma involving inferior vena cava in 3 cases, liver cancer involving inferior vena cava in 2 cases, right adrenal pheochromocytomas in 2 cases, retroperitoneal fibrosarcoma involving inferior vena cava in 1 case. According to tumor involvement types, the different surgical approaches, planes and method of inferior vena cava exclusion, reconstruction method and prevention of tumor embolus detachment were selected. Patients were followed up by outpatient examination and telephone interview till May 2015. Results Among 19 patients with renal cell carcinomas with inferior vena cava involvement, 10 patients were placed inferior vena cava filters through internal jugular vein before surgery, 10 patients underwent total hepatic vascular exclusion and 9 patients underwent intrahepatic inferior vena cavaexclusion. All the 19 patients received tumor resection and inferior vena cava embolectomy. Of the 5 patients with leiomyosar-comas of inferior vena cava, 3 patients underwent total hepatic vascular exclusion and 2 patients underwent intrahepatic inferior vena cava exclusion. The diseased segments of 5 patients were resected, including 4 patients of artificial vascular graft and 1 patient complicated with resection of right kidney receiving simple ligation of inferior vena cava and left renal vei