[1]易端 郭向阳 郑清＊.后腹腔镜肾癌根治性切除并下腔静脉癌栓取出术的麻醉管理[J].中国微创外科杂志,2014,14(12):1140-1143.
　Yi Duan,Guo Xiangyang,Zheng Qing..Anesthetic Management for Retroperitoneoscopic Nephrectomy Combined with Inferior Vena Cava Tumor Thrombectomy[J].Chinese Journal of Minimally Invasive Surgery,2014,14(12):1140-1143.
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后腹腔镜肾癌根治性切除并下腔静脉癌栓取出术的麻醉管理()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
14
期数:
2014年12期
页码:
1140-1143
栏目:
短篇论著
出版日期:
2014-12-20

文章信息/Info

Title:
Anesthetic Management for Retroperitoneoscopic Nephrectomy Combined with Inferior Vena Cava Tumor Thrombectomy
作者:
易端 郭向阳 郑清＊
北京大学第三医院麻醉科，北京100191
Author(s):
Yi Duan;  Guo Xiangyang;  Zheng Qing.
Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
关键词:
后腹腔镜; 肾癌根治术; 癌栓取出术; 麻醉管理
Keywords:
Retroperitoneoscopy; Nephrectomy; Thrombectomy; Anesthetic management
分类号:
R614.2
文献标志码:
A
摘要:
目的探讨后腹腔镜肾癌根治性切除并下腔静脉癌栓取出术的麻醉管理要点。 方法回顾性分析2010年12月~2014年6月3例后腹腔镜肾癌并下腔静脉癌栓根治术患者的围术期临床资料。Ⅰ型癌栓2例，Ⅱ型癌栓1例。气管插管全身麻醉，Ⅱ型癌栓术中行短暂下腔静脉阻断。结果3例均顺利完成取栓，无中转开腹，手术时间244、333、289 min，1例下腔静脉完全阻断时间10 min，术中均未发生肺栓塞及其他严重麻醉并发症。1例术后拔管返回普通病房，2例转入ICU后24 h内拔气管导管并转回普通病房。 结论后腹腔镜肾癌根治性切除并下腔静脉癌栓取出术是新型、高危但可行的手术方式，麻醉医师应当熟知具体手术操作步骤，以制定相关麻醉计划并密切配合，密切关注下腔静脉阻断期间循环波动，严防大出血、肺栓塞等严重并发症的发生。
Abstract:
ObjectiveTo evaluate the key points of anesthetic management for retroperitoneoscopic nephrectomy combined with inferior vena cava (IVC) tumor thrombectomy.MethodsPerioperative clinical data of 3 patients undergoing retroperitoneoscopic nephrectomy combined with IVC tumor thrombectomy from December 2010 to June 2014 were retrospectively analyzed. There were 2 cases of level Ⅰ thrombus and 1 case of level Ⅱ thrombus. All the patients were given general anesthesia with intubation. Brief inferior vena cava occlusion was performed in the patient with level Ⅱ thrombus.ResultsThe operation was completed smoothly in all the cases without conversions to open surgery. The operating time was 244, 333, and 289 min, respectively. The total IVC control time for level Ⅱ thrombus was 10 min. No intraoperative pulmonary embolism and other severe anesthetic complications occurred. One patient with level Ⅰ IVC thrombus was extubated and sent back to surgical ward after surgery, and the remaining 2 patients underwent intensive care monitoring overnight and were extubated and discharged to surgical ward on the next day.ConclusionsRetroperitoneoscopic nephrectomy and IVC thrombectomy is a brandnew, difficult but feasible procedure. Anesthesiologist should have a full recognition of surgical procedures and make perfect anesthetic plan to ensure close collaboration. Furthermore, circulatory swing during IVC clamping and perioperative severe complications such as pulmonary embolization and massive hemorrhage cannot be neglected.

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备注/Memo

备注/Memo:
基金项目：北京大学第三医院临床重点项目（批准号：63531-03）＊通讯作者，Email:zhengqing1970@live.cn
更新日期/Last Update: 2014-12-20