550
2515581226014562122177
Ces36817936014570127174
Urol38807936014578115180208
2022;41137936014562121178238261
26(4):43997936014562120153210240262
250–25546867936014562122181245300360416
KAZUISTIKY4325207016976175264361404481560603687776
SUMMARY625884014762143243345423493561
Hanáček7741048013171122181232282334382
V,1181104801316678
Borovička12841048013166126160218268292342389441
V,1750104801316679
Chlupáč18541048013173132155214276327378
J,2257104801314765
Froněk2347104801316191150210265312
J.2684104801314766
Inferior624119801312381109161192215273305
vena953119801314799157205
cava1182119801314797144194
reconstruction1400119801313082131187246285319351409458494516574633
in2057119801312078
a21591198013147
patient22301198013158108140163215273305
with2559119801317799133191
locally624134801312381131181203224272
advanced9211348013149109158208266315365426
and13711348013150107167
recurrent1562134801313284133191222254306364396
renal1982134801313284142190212
cancer.2219134801314998156205256287301
Locally7741498013149106155205227249297
advanced10951498013152112161211269318368429
renal1548149801313586144193215
cell17871498013151102125147
carcinoma19581498013151101132179200258316406455
is2437149801312564
asso‑2525149801315392132190225
ciated624164801314971119151202262
with9111648013186109142200
a11351648013157
malignant12171648013197146168190249306355413445
thrombus1686164801314199130187276336394433
of2144164801316594
the2262164801314199152
inferior2438164801313188116168199222280312
vena6241798013151104163213
cava8611798013159110158209
(IVC)1095179801313860117180211
in1331179801313190
approximately14461798013159120181214272319342432482515568591640
1021111798013163111
%22471798013190
of2362179801316897
cases.24841798013158109150204245266
Complete6241948013163119209268291344377428
tumor1077194801314199188247279
resection1380194801314092132185235271293351409
in1814194801313088
the19261948013142100153
form2103194801313794127217
of2344194801316695
a24631948013158
radi‑2545194801314090150171205
cal624209801314999121
nephrectomy7692098013162115175233264316365402458547593
and13862098013153111170
caval15812098013151101149199221
thrombectomy1826209801313795126182272332386435471527617663
is2513209801312665
the2602209801313795148
most6242248013190148188223
effective871224801315685115167217253275324376
curative12712248013152109141191223245294346
option16412248013161122155177234293
in1958224801312683
indicated2065224801312684143165214263295346407
cases.24962248013152102141194235254
In624239801312379
some727239801313693181233
instances,983239801311975113147195252299349388406
resection1412239801312879118170218253274331388
of1823239801315482
the1928239801312986138
IVC2089239801311974133
is2245239801311957
necessary.23252398013154106154204243282331361412425
Cadaveric6242548013163112172221268320351374422
allografts107025480131466890148208240289317355396
or1491254801315486
synthetic1601254801313887146178236289322344392
vascular2017254801314696136184242264312344
prosthe‑2385254801315789145185220278331365
ses624269801314297139
represent788269801314295157190243285340400433
the12462698013143103158
most142926980131101162203239
commonly16932698013159117209301361421445494
used22132698013168109164226
grafts.24642698013170103154183222266286
A6242848013165
malignant7132848013199148170192252310359417449
thrombus11862848013143101133190280340398438
of1648284801316796
the17682848013142101154
IVC1947284801313187149
is2120284801313170
a22152848013158
significant2297284801315071131189211237264312363421453
adverse6242998013150109158209240281333
prognostic981299801315789145205262320359394415463
factor,1468299801312575123159215246259
and17512998013146104163
it1937299801311952
is2013299801311958
associated2095299801314685125182231253301333383443
with2562299801317597130188
a6243148013150
higher698314801315476135192244276
risk99731480131295190135
of1155314801315583
disease1262314801315677116168216256308
recurrence.1594314801312980129186217249300357406456473
The20913148013147106159
time2274314801313052140193
to2490314801313186
iso‑2600314801311958115150
lated624329801312372104155215
recurrence863329801313183132190221253305363411462
after1349329801314977114165197
primary1570329801315991113202251282334
surgery1928329801314096127185238270321
is2274329801312160
between23583298013159113146228280334392
19624344801315499
and7473448013150107167
369383448013154106
months.10683448013190148207239297336356
Case:7743593013564118162217241
A10333598013163
64-year-old11193598013149103137183234281311339398420478
male16203598013184132153204
with1848359801317495127184
locally2055359801311975124172193214261
advanced23393598013145103151199255303352411
right-sided624374801313255114172204233273294354406467
renal1115374801314092150199221
cell13603748013157108131152
carcinoma15373748013157106138184206264322412461
and20223748013158116175
a22213748013158
malignant23033748013198147170191250308357415447
IVC624389801312379140
thrombus788389801313593124181270330388428
extending12403898013154102138189247307329386446
below17103898013162116138196274
the2008389801313694147
hepatic21793898013160113173223255277325
veins25283898013151103125182222
underwent6244048013158114172223254334385441472
a11194048013145
radical1187404801312877135156203251272
nephrectomy14834048013153105163220251301349384438526571
and20774048013145102160
resection2260404801312778117168217252273329386
of2669404801315481
the624419801313492144
IVC792419801312075136
with952419801317598131188
reconstruction1164419801312980129185243283317348406455491513570628
using1816419801315594115172231
a20714198013146
cadaveric2141419801314595154202250301333355403
allo‑256841980131466890147182
graft.624434801316091141169206225
Twenty-nine8734348013148119171229260312344403425482535
months14324348013187145203235293332
after1788434801314674112162194
the2006434801313088141
initial217143480131197798132154202224
surgery,2419434801313794125183235267318331
we6244498013180133
performed7824498013169124156188246279370424485
resection1291449801314194134188239275298356416
of1731449801316796
the18524498013142101155
locally2032449801313190140191213236284
recurrent2341449801314193143201233266318377409
tumor624464801313492181239271
with9194648013178101134192
repeated1135464801313283143197245277328388
replacement1547464801313283143166215263314403456514546
of2117464801315786
the2227464801313391144
IVC2395464801312278139
with25584648013178101134192
a6244798013149
synthetic696479801313785142173230281313334381
prosthesis.1101479801315586141180214270322361381419438
The15624798013146105156
patient17414798013156105136157208265295
is2060479801311856
in2139479801311975
good22374798013155111169228
health24884798013154105152173206262
36244948013154
months7024948013190148207239297336
after1062494801315078115166198
the1284494801313492145
second1453494801314194144200258318
resection.1795494801313284124177226263285342401420
Conclusion:7745093013567130195246276341388418482547574
Radical13815098013157109171195245297321
surgical17275098013153112145205228279331355
resection2107509801314497140195247285309369430
of25635098013170100
a26885098013162
renal624524801313284142191213
tumor861524801313289178236268
with1154524801317799132191
caval1369524801314696144193216
thrombectomy1609524801313189120177267326380430466522612658
or2291524801315688
replace‑2403524801313082141164213262312347
ment6245398013190143201233
due8815398013156113166
to1071539801313187
malignant11825398013186135157179238296344402434
IVC1640539801312075136
thrombus1800539801313189120176266326384423
remains2247539801312981170218240298337
the2608539801313189142
only6245548013158116138186
therapeutic833554801313088141172221280334391424446494
option13505548013155115147169226284
associated1658554801314685125182231253301333383443
with2125554801317597130188
improved23375548013119107166197253301353413
survival624569801314197129182205254304326
rates.974569801312979112163203222
In1220569801312178
our13225698013156114145
case,1491569801314796136189206
we17215698013176129
carried1874569801314695127159182234294
out21935698013155113147
repeated2364569801312981140194243275326386
replacement624584801313284143166214263313402455513544
of1192584801315583
the1299584801313088141
IVC1464584801311975135
while16235848013176134156177230
treating1877584801313062113161193215272331
primary2232584801315789111200248279331
and25875848013146104163
recurrent624599801313284133191222254306364396
disease.1044599801315981120173221261314331
KEY6256284014770134206
WORDS85762840147106190261346409
Renal6246448013157112172223247
cell8966448013159112136159
carcinoma,10806448013159111144192215275335428479499
malignant160464480131101152176198260320370430464
thrombus,20936448013143104136195288350410451471
ne‑25896448013170125161
phrectomy,6246598013161119151202252288344433480493
inferior1141659801312380108160191214272304
vena14696598013150101159208
cava1701659801314999147196
reconstruction1921659801313384134190248288322354412461497519577635
………62468840147120240360
ÚVOD2978858018197183286388
Karcinom29761198013154105135181202259316405
ledviny3405119801311971130179201258303
byl37321198013156102125
v38811198013145
České39491198013159109148193243
republice4216119801312879138195254276297345395
v46341198013146
roce4703119801312884133183
201849101198013149100147192
diagnostikován2976134801315980128186242300339372394438494541590646
311436461348013149114154200
pacientům38691348013156105153174225282313369456
s43491348013136
incidencí4409134801311875122143201253310358379
29,348111348013149100113166
na50001348013154102
1000002976149801315398152217270323
obyvatel33221498013153112158209258288338359
(1).370414980131257190104
Česká38311498013157107146189238
republika4092149801312878136192250272292336385
se4500149801313688
celosvětově4611149801314493115171209258308340394441491
pohybuje29761648013160117174219278335356407
na34061648013154101
předních3530164801315687136195251272319375
příčkách3928164801315586108154198247294350
v43021648013144
incidenci4369164801311975122143200252308355376
karcino‑4768164801314291121167187243300334
mu29761798013190147
ledviny.3147179801312174134184207264310324
Lokálně34951798013147103149200222280333
pokročilý38521798013158117164197253303324346394
karcinom4270179801314495126173195252311400
ledviny4694179801312174134184207264310
je5028179801312174
přibližně2976194801316192115174197218262320373
v33721948013146
103442194801315097
%35631948013177
případů3664194801315789111170220279336
spojen4024194801313796155177230287
s43351948013137
výskytemmalig‑4396194801314698138183235272323411522570592614673706
ního2976209801315879137194
trombu3193209801313060115203261318
dolní35342098013155111133189210
duté37672098013155110143192
žíly398320980131396184131
(DDŽ).4137209801312493162215244259
Maligní44192098013180128149170227284304
trombus4746209801313060115203261318356
DDŽ29762248013171142197
je3197224801313083
považován33042248013167126175224269325373423481
za38092248013151102
nepříznivý39352248013166119178210233276335357406458
faktor.4417224801313686132169225257270
Radikální47122248013162111171193238289311368390
nefrektomie29762398013159113141175226273310366457479532
a35322398013158
kavální36152398013155106154204227285307
trombektomie3946239801314274131222282336382420476566589642
představují46122398013169101153214254288338386445468490
v29762548013151
indikovaných3052254801313292153176223282332383443490540599
případech36772548013170103127188240302356407467
nejúčinnější41692548013169124147206256279338398453476516538
metodu473325480131100155190248310369
léčby2976269801312376125185232
těchto3232269801313485134192224280
karcinomů.3536269801314697128175197254313402459476
Předoperační3126284801315585136196253313367398447495553574
multimodální37242848013186142164197219307365425473495552574
CT43212848013159113
nebo44582848013155107167225
MR47072848013181136
hrud‑4867284801315585143202235
níku,2976299801316082131190209
břicha32102998013170102126175234284
a35192998013159
malé360229980131100150173227
pánve38542998013170121180229282
jsou4160299801313373132191
zásadní43762998013153105146197258317340
k47402998013156
určení48212998013167100147199258281
rozsahu2976314801313289131174224282339
maligního33393148013192140163184243301323383441
trombu3804314801313567124213273331
a41593148013151
volbě42343148013151108132191245
operační45033148013160120174205255304361383
stra‑4910314801314277109159192
tegie.2976329801313383141162213229
V32283298013151
současnosti3302329801313693149196244282338395433467488
je3813329801311970
u39063298013153
renálního3982329801312777134181202258278337393
karcinomu4398329801314291121167187243300387443
široce486432980131365686141189238
užívaná29763448013158102125174224282330
Mayo33313448013190139186243
klasifikace3598344801315276125164186212238283334383434
trombu4056344801313971127217276334
DDŽ44153448013176147201
(Tab.4640344801313589131191208
1)4872344801315979
(2).4975344801313586112127
Perioperační29763598013155106137160217278332363413462519541
jícnová354135980131285098156214262312
echokardiografie38773598013158107165223270320352410431489549581631656683736
dává46373598013164113160210
infor‑4871359801312885113170202231
maci29763748013189136184205
o32043748013154
aktuální3281374801314589125181229250306327
propagaci3631374801315687142201250308355403424
trombu,4078374801312960115203261318335
o44373748013153
jeho4513374801311971128184
případné4721374801315586108166215273329381
embolizaci29763898013152139197255277297339388436456
při3455389801315686108
manipulaci35863898013184131187208265322343390437458
s40673898013136
DDŽ41263898013165134187
a43363898013145
posuzuje44043898013155113151206249305327378
srdeční4805389801313665121173220276297
funkci2976404801312988145191238260
(3).3260404801312980105120
U31264198013169
některých32194198013161114159196247278330378435
tumorů3679419801313693182240272331
je4034419801312578
z41364198013146
důvodů42064198013162119168225285342
onkologické45724198013161119165222245303363385433478530
radikality2976434801313281140161205255277298331381
vyžadována3380434801314697142192251308355404461509
kompletní3912434801314398187245268320352410431
resekce4366434801312879118171215262312
části4701434801314594133166188
DDŽ49124348013167136190
s29764498013141
její3041449801312982104125
následnou31904498013165113153175228288346404462
náhradou.36764498013164113171202252312370428446
V41474498013161
takových4232449801313989134191239291339397
případech4653449801316697120179229289342391449
je2976464801312375
možná30744648013185142184241289
náhrada33864648013154102159189238296344
allograftem,375346480131456788145204234283310347397484502
protézou,4278464801315687142174224267323379397
bovinním46984648013156114161183239296317404
perikardem29764798013160114144167211261292349401490
či3489479801314566
autotransplantáty,35794798013145102135190222253302359398457479527584615664696747759
nejčastěji43624798013155107128176225264298348369391
uprave‑47764798013154113145194241292326
nou29764948013159117175
velkou31754948013150102124169226284
safénou3483494801314191119171229288346
či3853494801314970
stehenní3947494801314176127185238296354375
žílou434649480131456792150207
(4).4578494801312978104119
V31265098013156
našem32065098013157106145198287
článku3517509801314769118176221279
prezentujeme3820509801315991143187239296328386408461550603
kazuistiku4447509801314595140198220259294316361419
paci‑48905098013159109157179212
enta29765248013153111143193
s31935248013147
lokálně3264524801312987133184207264317
pokročilým36055248013167126172205262311333355403493
renálním4122524801313990148197219276298387
karcinomem,45335248013153103135181203261319409462551569
který2976539801314783134166218
podstoupil32185398013161120180220254310368428450472
pravostrannou3714539801316193143191248288322354404462520578636
nefrektomii43745398013159113141174225271308364453475497
s48955398013141
ná‑49605398013160109142
hradou2976554801315990140200258316
DDŽ33165548013169140194
allograftem353555480131487092150210241291319357408497
a40565548013148
s41285548013139
odstupem41915548013157117157191249309363452
2946675548013152103
měsíců47945548013189142182203251308
resekci2976569801313282120172216261282
lokální3281569801311874119168189245265
recidivy3569569801312877125146203224271321
s39135698013136
protetickou3972569801315586141172221253274320364419475
náhradou44705698013153100156186235292348404
DDŽ.48975698013166134187205
Tab.29765992013759109173200
1.3197599201375779
Klasifikace3330599801315173126160179202227270322365408
trombu3757599801312857108193246300
dolní40765998013151104125179199
duté42945998013151104134176
žíly448959980131406082125
podleMayo46335998013151105159180224321374417470
Clinic2976614801315980102157178223
Tab.29766292013762114182211
1.3210629201377095
Mayo33636298013185141187242
Clinic3625629801316890112169191237
classification3883629801315375131168205226251277323377409431487544
of4448629801316391
Inferior4560629801313088115161193215271303
Vena48846298013162106163219
Cava29766448013159112158210
Throbus32066448013149105136188243298334
Stupeň3018661201104778129182230282
Definice34236612011061109135160212236276323
030186763010744
Trombus3423676301074263110184234282315
je3758676301071963
omezen38416763010747122166203246294
na4155676301074889
renální4263676301072770118159178226244
žílu452767630107365576123
I30186910010719
Trombus3423691001074263110184234282315
se3758691001073377
propaguje3855691001075077124174216265313331375
do4250691001074997
DDŽ43676910010758117162
≤45496910010754
246226910010744
cm46866910010740114
nad4820691001074889138
renální3423701001072770118158177225244
žílu368670100107375676124
II3018715801071938
Trombus3423715801074263110184234282315
se3758715801073377
propaguje3855715801075077124174216265313331375
v42507158010741
DDŽ43107158010759117163
≥44937158010753
245667158010744
cm46307158010740113
nad4763715801074889138
renální3423725801072770118158177225244
žílu,368672580107375676124139
ale3845725801074160104
pod3969725801074998148
jaterní413772580107196087129156205223
žíly438072580107365576116
III301874050107193857
Trombus3423740501074263110184234282315
se3758740501073377
propaguje3855740501075077124174216265313331375
v42507405010741
DDŽ43107405010759117163
nad4493740501074888138
jaterní465174050107195986129155204223
žíly,489374050107375677117128
ale3423750501074160104
pod3546750501075099149
bránici3715750501075077118166185225244
IV3018765301071965
Trombus3423765301074263110184234282315
se3758765301073377
propaguje3855765301075077124174216265313331375
nad4250765301074889138
bránici4408765301075077118166185225244