侵入下静脉的瘤的手术管理:德尔菲共识文件
Peter Balaz1, Adam Whitley2, Ivika Heinola3
1Division of Vascular Surgery, Department of General Surgery, University Hospital Královské Vinohrady, Prague, Czech Republic; Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
概括
专家一致认为,治疗涉及下腔静脉 (IVC) 的形瘤是必要的. 关键建议包括CT成像,IVC重建用于上腺参与,以及IVC恶性瘤的特定血栓切除或切除策略.
科学领域:
- 血管外科 血管外科
- 手术瘤学手术瘤学
- 医疗成像医学成像
背景情况:
- 涉及下腔静脉 (IVC) 的逆皮质恶性瘤由于有限的数据和不一致的管理策略,提出了治疗挑战.
- 在这些复杂的病例中,建立专家共识对于指导手术决定至关重要.
研究的目的:
- 建立有关涉及下腔静脉 (IVC) 的瘤的外科治疗的专家共识.
主要方法:
- 一个为期三轮的Delphi项目,涉及14名外科专家.
- 数据收集发生在2023年1月1日至2023年12月15日之间.
- 共识被定义为70%的同意,使用克伦巴赫的α (0.05) 进行统计验证.
主要成果:
- 腹部计算机断层扫描 (CT) 是评估IVC瘤入侵的黄金标准;CT引导的核心针活检是组织诊断的首选.
- 应该重建上IVC,但如果长期被附带循环堵塞,则不应该重建.
- 没有血管壁参与的恶性血栓需要进行血栓切除;否则,建议进行IVC切除,最好使用扩展聚四乙烯 (ePTFE) 假肢.
- 不建议使用IVC过器和动脉静脉. 手术后的护理包括治疗性肝素化,机械压缩和常规CT血管造影.
结论:
- 这份专家共识为管理涉及IVC的瘤的临床医生提供了指导.
- 这些建议基于有限的文献和国际专家经验,旨在改善决策过程.
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