背景:下腔静脉(IVC)切除术对于某些恶性肿瘤的完全(R0)切除至关重要。然而,IVC重建的最佳材料仍不清楚.我们的目标是证明疗效,安全,使用非筋膜自体腹膜(NFAP)进行IVC重建的优势。对累及IVC的肿瘤的手术策略进行文献综述。
方法:我们回顾了2015年至2023年在我们机构进行的所有IVC重建。术前,Operative,术后,收集和分析随访数据。
结果:确定了总共33个连续的IVC重建:七个直接缝线,八个静脉同种异体移植物(VH),18NFAP关于NFAP,八个管状(平均长度,12.5厘米)和10片(平均长度,进行7.9cm)IVC重建。89%的病例切除为R0。两名患者有Clavien-DindoI级并发症,2二级,2个Ⅲ级和2个Ⅴ级并发症。唯一的移植物相关并发症是早期部分血栓形成,这是保守治疗。平均随访25.9个月,移植物通畅率为100%。有7例复发和6例死亡。平均总生存期(OS)为23.4个月,平均无病生存期(DFS)为14.4个月。根据我们的结果,NFAP和VH之间无统计学差异。
结论:NFAP是部分或完全IVC重建的安全有效替代方法,与其他技术相比具有许多优势,包括它缺乏成本,广泛和现成的可用性,极端的方便,和多功能性。需要进一步的比较研究来确定IVC重建的最佳技术。
Inferior vena cava (IVC) resection is essential for complete (R0) excision of some malignancies. However, the optimal material for IVC reconstruction remains unclear. Our objective is to demonstrate the efficacy, safety, and advantages of using Non-Fascial Autologous Peritoneum (NFAP) for IVC reconstruction. To conduct a literature
review of surgical strategies for tumors involving the IVC.
We reviewed all IVC reconstructions performed at our institution between 2015 and 2023. Preoperative, operative, postoperative, and follow-up data were collected and analyzed.
A total of 33 consecutive IVC reconstructions were identified: seven direct sutures, eight venous homografts (VH), and 18 NFAP. With regard to NFAP, eight tubular (mean length, 12.5 cm) and 10 patch (mean length, 7.9 cm) IVC reconstructions were performed. Resection was R0 in 89% of the cases. Two patients had Clavien-Dindo grade I complications, 2 grade II, 2 grade III and 2 grade V complications. The only graft-related complication was a case of early partial thrombosis, which was conservatively treated. At a mean follow-up of 25.9 months, graft patency was 100%. There were seven recurrences and six deaths. Mean overall survival (OS) was 23.4 months and mean disease-free survival (DFS) was 14.4 months. According to our results, no statistically significant differences were found between NFAP and VH.
NFAP is a safe and effective alternative for partial or complete IVC reconstruction and has many advantages over other techniques, including its lack of cost, wide and ready availability, extreme handiness, and versatility. Further comparative studies are required to determine the optimal technique for IVC reconstruction.