【摘要】 目的 探讨采用无开胸及体外循环下，采用完全腹腔镜下部分阻断肝下腔静脉，抽出癌栓并左肾根治性切除的方法治疗左肾细胞癌并MayoⅣ级游离腔静脉癌栓的策略、技术及短期疗效。方法 收集暨南大学附属第一医院一例54岁男性肾癌伴腔静脉癌栓患者的临床资料，患者术前诊断为为左肾占位并下腔静脉癌栓，癌栓上界位于膈上腔静脉、近右心房入口（MayoⅣ级）。手术前1 d行左肾动脉栓塞。手术当天做好体外循环准备后，取右70°半侧卧位，在传统3D腹腔镜下部分阻断肝下腔静脉，顺利取出癌栓，取栓全程采用经食道超声监测。后改为左70°半侧卧位行左肾根治性切除+左侧腹膜后淋巴清扫术。结果 手术顺利完成，手术时间为530 min，术中出血约450 ml，术后恢复顺利，术后1周出院。术后予抗凝3个月及辅助靶向治疗。术后13个月随访未见肿瘤复发。结论 采用免体外循环和开胸的完全腹腔镜下部分阻断肝下腔静脉抽取癌栓的方法对于部分严格选择的瘤体较细、游离的MayoⅣ级腔静脉癌栓微创、可行，尤其减少了开胸和体外循环可能的并发症，有助于患者恢复，但需要等多的病例和更长期的随访证实其疗效。更多还原

【Abstract】 Objective To investigate the strategy, technique and short-term efficacy of partial clamping of the suprahepatic inferior vena cava(IVC) and aspiration of thrombus without median sternotomy and cardiopulmonary bypass under total 3D laparoscopy, combination with left radical nephrectomy in the treatment of left renal cell carcinoma with level Ⅳ IVC thrombus. Methods The data of 54-year-old male patient in the First Affiliated Hospital of Jinan University with left renal tumor and level Ⅳ IVC thrombus was collected, the upper border of the thrombus of the patient reaching to the entrance of the right atrium(Mayo Ⅳ). Left renal artery embolization was performed one day before operation. On the day of operation, after the preparation for cardiopulmonary bypass, the patient was placed in the 70° right lateral decubitus supine position, clamped the suprahepatic IVC partially and extracted the thrombus successfully under Storz 3D laparoscopy. The whole process of extracting thrombus was monitored by transesophageal ultrasound. Then the posture was changed to 70° left lateral decubitus supine position for radical left nephrectomy and left retroperitoneal lymphatic dissection. Results The operation was completed successfully with an operative time of 530 min, the intraoperative blood loss was 450 ml. The patient recovered smoothly and was discharged one week later. In addition, the patients received anticoagulation for three months and adjuvant targeted therapy. Imaging examination showed that there was no tumor recurrence in the thirteen months follow-up. Conclusions The method of complete laparoscopic partial blockade of the inferior hepatic vena cava and thrombus aspiration without extracorporeal circulation and open chest is minimally invasive and feasible for some of the level Ⅳ IVC thrombus which are small and free. It could reduce the possible complications caused by open chest and extracorporeal bypass and help patients recover quickly, but more cases and longer-term follow-up are needed to confirm its efficacy.更多还原