目的：探讨肾癌根治性切除加下腔静脉癌栓取出术治疗Mayo Ⅲ级下腔静脉癌栓（inferior vena cava tumor thrombus，IVCTT）的有效性和安全性，总结手术技术及临床经验。方法：回顾性分析2014年10月至2016年9月北京大学第三医院泌尿外科收治的8例肾癌合并Mayo Ⅲ级（美国Mayo医学中心分级法）IVCTT患者的临床资料。8例患者中男性3例，女性5例，年龄18~77岁，平均（58.0±18.7）岁，体重指数（body mass index，BMI）为15.2~30.8 kg/m2，平均(22.7±4.4) kg/m2。8例患者的肿瘤均位于右侧，肿瘤直径(7.9±2.5) cm。行开放肾癌根治性切除加下腔静脉癌栓取出术者5例，行腹腔镜下肾癌根治性切除加下腔静脉癌栓取出术者3例，其中1例患者行中转开放手术。结果：8例患者手术均顺利完成，无围术期死亡病例。手术时间272~567 min，平均(370.3±101.6) min。下腔静脉阻断时间17~55 min，平均(41.0±12.1) min。术中出血量200~3 000 mL，平均(1 181.3±915.7) mL。术中输注悬浮红细胞者5例，输入量800~2 000 mL，平均(850.0±783.8) mL。术中输注血浆者3例，输入量400~1 000 mL。术后住院时间9~23 d，平均(14.1±4.0) d。8例患者中4例因术中发现癌栓侵犯下腔静脉壁而行下腔静脉壁切除术。8例患者术前血肌酐值60~101 μmol/L，平均(76.4±15.3) μmol/L，术后1周血肌酐值74~127 μmol/L，平均(100.8±21.1) μmol/L。术后组织病理检查诊断为肾透明细胞癌（renal clear cell carcinoma，RCC）6例，肾乳头状腺癌（papillary adenocarcinoma）1例，Fuhrman分级为Ⅲ级6例、Ⅳ级1例，尤文肉瘤（Ewing’s sarcoma）1例。8例患者中，5例发生术后早期并发症，均为ClavienⅡ级并发症，未见严重并发症发生。8例患者均获随访，随访时间2~24个月，平均11.3个月。术前未发现远处转移的7例患者中，出现远处转移1例，为肺转移。结论：肾癌根治性切除加下腔静脉癌栓取出术治疗Mayo Ⅲ级下腔静脉癌栓较为有效、安全。Ⅲ级静脉癌栓延伸范围广，手术技术难度较大，充分的术前准备、丰富的解剖学知识和手术操作经验可提高手术安全性。

Objective： To evaluate the effectiveness and safety of radical nephrectomy and inferior vena cava thrombectomy in the treatment of patients with Mayo Ⅲ tumor thrombus, and to introduce our experience and surgical technique. Methods: The clinical data of 8 patients with Mayo Ⅲ tumor thrombus from October 2014 to September 2016 were analyzed retrospectively. Of the 8 patients, 3 were male and 5 were female. The average age was (50.8±18.7) years (18 to 77 years). The average body mass index (BMI) was (22.7±4.4) kg/m2 (15.2 to 30.8 kg/m2). Imaging suggested the right renal tumor in all the 8 cases. The average tumor size was (7.9±2.5) cm. Open radical nephrectomy and inferior vena cava thrombectomy was conducted in 5 cases and laparoscopic surgery in 3 cases, and 1 case was converted to open surgery. Results: All the 8 surgeries were completed successfully with no death case. The average surgery time was (370.3±101.6) min, ranging from 272-567 min. The average vena cava blocked time was (41.0±12.1) min, ranging from 17-55 min. The blood loss volume was (1 181.3±915.7) mL, ranging from 200-3 000 mL. During the operation, 5 cases were infused with suspended red blood cells, the amount of blood transfusion was 800-2 000 mL. 3 cases were infused of plasma with 400-1 000 mL. The average hospital stay was 9-23 d, with an average of (14.1±4.0) d. In the 8 patients, 4 cases underwent inferior vena cava wall resection because of invasion by tumor thrombus. Preoperative serum creatinine was 60-101 μmol/L, with an average of (76.4±15.3) μmol/L. Serum creatinine 1 week after the operation was 74-127 μmol/L, with an average of (100.8±21.1) μmol/L. Pathological diagnosis showed 6 cases of clear cell carcinoma, 1 case of papillary carcinoma type Ⅱ, and 1 case of Ewing’s sarcoma. Among the 8 patients, early postoperative complications occurred in 5 cases. Postoperative complications were graded as level Ⅱ, according to the Clavien classifications. The 8 cases were followed up for 2 to 24 months with an average of 11.3 months. There was 1 patient who suffered from lung metastasis. Conclusion: Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo Ⅲ tumor thrombus. The wide extension of grade Ⅲ vein tumor thrombus leads to the difficulty of operation technique. Sufficient preoperative preparation, rich operative experience and skills can improve the safety of operation.