目的：探讨腔静脉节段切除术治疗侵犯腔静脉的肾肿瘤瘤栓的可行性、安全性和手术经验。方法：2015年5月至2017年7月，北京大学第三医院共收治92例肾肿瘤伴静脉瘤栓的患者，其中17例患者因瘤栓侵犯腔静脉壁需行腔静脉节段切除术。本组病例的特点为：男性15例、女性2例，平均年龄为（59.2±12.9）岁（31~84岁）；左侧6例，右侧11例；Mayo静脉瘤栓分级Ⅱ级10例、Ⅲ级３例、Ⅳ级４例；肾肿瘤最大径平均为（9.1±3.7）cm（3.0~14.5 cm）。结果：所有患者均成功完成手术，5例腹腔镜下完成（中转开放2例），12例开放手术完成（伴体外循环2例），平均手术时间为（430.4±120.7） min（284~694 min），术中平均失血量为（2 918.8±2 608.2）mL（300~10 000 mL）。腔静脉内瘤栓中位长度为10 cm（3~21 cm），手术切除范围是从瘤栓顶端水平到瘤栓底部水平。发生术后并发症患者11例，分别为Clavien分级Ⅰ级1例、Ⅱ级7例、Ⅳ级2例和Ⅴ级1例（术后第2天因大出血死亡）。术后肌酐中位数为116 μmol/L（79~645 μmol/L），其中2例需术后床旁血液滤过或透析。术后病理为肾透明细胞癌10例、乳头状细胞癌2型5例、尿路上皮癌1例、梭形细胞肉瘤1例。中位随访时间为8个月（1~28个月），1例围术期死亡，1例术后9个月因多发转移死亡，3例患者发现远处转移，2例术后随访3~6个月仍有双下肢水肿，其余患者恢复情况和治疗效果良好。结论：对于某些侵犯腔静脉的肾肿瘤瘤栓的患者，可行腔静脉节段切除完成手术，短期随访手术效果良好。

Objective：To investigate the safety and perioperative experience of the segmental resection of the vena cava. Methods: From May 2015 to July 2017, 92 renal tumor patients with venous tumor thrombus were treated in Peking University Third Hospital, of whom 17 underwent nephrectomy with resection of the invaded vena cava for renal tumor with tumor thrombus invading vena cava. The preoperative features included that 15 patients were male and 2 female, the mean age was (59.2±12.9) years (31-84 years), 6 cases were left sided and 11 right sided, and the mean diameter of the renal tumor was (9.1±3.7) cm (3-14.5 cm). Results: In this group of 17 cases, 5 patients underwent resection of the vena cava via laparoscopy (including 2 open conversions), and 12 via open procedures (including 2 cardiopulmonary bypasses). The mean operation time was (430.4±120.7) min (284-694 min) and the mean intraoperative blood loss was (2 918.8±2 608.2) mL (300-10 000 mL). The vena cava from the bottom to the top was transected. The median length of the tumor thrombus in the vena cava was 10 cm (3-21 cm). Postoperative complications were found in 11 patients, including grade Ⅰ in 1 case, grade Ⅱ in 7 cases, grade Ⅳ in 2 cases and grade Ⅴ in 1 case according to the Clavien system. The median postoperative creatinine was 116 μmol/L (79-645 μmol/L) with 2 patients needing dialysis. The postoperative pathology revealed that renal clear cell carcinoma in 10 cases, papillary carcinoma in 5 cases, urothelial carcinoma in 1 case and fusiform cell sarcoma in 1 case. During the median followup of 8 (1-28) months, 1 patient died during perioperative period, 1 patient died from multiple metastasis in 9 months postoperatively, 3 patients found distant metastasis and 2 cases remained lower extremity edema after operation. Conclusion: The segmental resection of the vena cava may be a good choice for non-metastatic renal tumors with tumor thrombus invading vena cava. The short term follow-up results revealed a satisfactory safety and feasibility.