腎腫瘍に対する下大静脈切除術 : 腎静脈門脈吻合の実験的研究

概要

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The renal cell carcinoma often involves directly the inferior vena cava. The method of the curative treatment for such a case is radical nephrectomy with en bloc resection of the inferior vena cava containing tumor. However, excision of the vena cava extends above the contralateral renal vein, results in passive renal congestion and failure when adequate venous collaterals are not developed. As one of the surgical methods to cure completely such a case without injuring the function of the remaining kidney, we studied on an resection of the inferior vena cava and on an end-to-side renoportal venous anastomosis. Using 7 mongrel adult dogs, we resected the left kidney and the inferior vena cava en bloc from above the left suprarenal vein to just above the iliac bifurcation, and made an end-to-side anastomosis between the right renal vein and the portal vein. At the same time, we ligated and divided the left spermatic (or ovarian) vein emptying to the left renal vein, the lumbar vein, the left suprarenal vein and the right spermatic (or ovarian) vein entering the resected vena cava. Five of these 7 dogs maintained excellent health and were followed up for 12 to 14 months. Two dogs died of bleeding and shock, 6 hours and 17 hours after the operation respectively.
社団法人日本泌尿器科学会の論文