[1]许川雅张展奕①张树栋①李民**.机器人辅助腹腔镜下肾癌合并Mayo Ⅱ级下腔静脉癌栓手术的麻醉管理[J].中国微创外科杂志,2026,01(7):397-402.
　Xu Chuanya,Zhang Zhanyi,Zhang Shudong,et al.3Anesthetic Management of Robotassisted Laparoscopic Surgery for Renal Cell Carcinoma With Mayo Grade Ⅱ Inferior Vena Cava Tumor Thrombus[J].Chinese Journal of Minimally Invasive Surgery,2026,01(7):397-402.
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机器人辅助腹腔镜下肾癌合并Mayo Ⅱ级下腔静脉癌栓手术的麻醉管理()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年7期
页码:
397-402
栏目:
临床研究
出版日期:
2026-08-06

文章信息/Info

Title:
3Anesthetic Management of Robotassisted Laparoscopic Surgery for Renal Cell Carcinoma With Mayo Grade Ⅱ Inferior Vena Cava Tumor Thrombus
作者:
许川雅张展奕①张树栋①李民**
(北京大学第三医院麻醉科，北京100191)
Author(s):
Xu Chuanya;  Zhang Zhanyi;  Zhang Shudong;  et al.
Department of Anesthesiology, Peking University Third Hospital, Beijing 100019, China
关键词:
机器人辅助根治性肾切除术; 腹腔镜; 下腔静脉癌栓; Mayo Ⅱ级; 麻醉管理
Keywords:
Roboticassisted radical nephrectomy; Laparoscopy; Inferior vena cava tumor thrombus; Mayo grade Ⅱ; Anesthetic management
文献标志码:
A
摘要:
目的探讨机器人辅助根治性肾切除术(roboticassisted radical nephrectomy，RARN)联合下腔静脉癌栓切除术(inferior vena cava tumor thrombectomy，IVCTT)的围术期麻醉管理与术后转归。方法回顾分析2022年1月~2024年12月我院84例Mayo Ⅱ级肾癌合并下腔静脉(inferior vena cava，IVC)癌栓行RARN+IVCTT的临床资料，根据IVC处理方式分为IVC阻断组(n=55)和IVC离断组(n=29)，比较2组麻醉指标(手术时间、气腹时间、出血量、输血量、血管活性药物使用情况等)和术后情况。结果IVC阻断组手术时间、气腹时间及麻醉时间显著长于IVC离断组(t=2.601，P=0.011；t=2.650，P=0.010；Z=-2.658，P=0.008)，术中净液体平衡量显著多于IVC离断组(t=2.397，P=0.019)。2组悬浮红细胞输注率［63.6%（35/55） vs. 55.2%（16/29）， χ2=0.570，P=0.450］和血浆输注率［38.2%(21/55) vs. 34.5%(10/29)， χ2=0.112，P=0.738］差异均无统计学意义。2组术中低血压(intraoperative hypotension，IOH)发生率分别为20.0%(11/55)和6.9%(2/29)，差异无显著性(χ2=1.591，P=0.207)。2组阻断或离断IVC时需要增加升压药物的比例分别为491%(27/55)和27.6%(8/29)，差异无显著性(χ2=3.613，P=0.057)。IVC离断组术后1 d丙氨酸氨基转移酶、天门冬氨酸氨基转移酶显著高于IVC阻断组(P<0.05)；2组患者术后急性肾损伤(acute kidney injury，AKI)发生率分别为18.2%(10/55)和10.3%(3/29)，差异无显著性(χ2=0.892，P=0.345)，ICU入住率及停留时间、术后住院时间差异无显著性(P>005)。结论RARN联合IVCTT治疗Mayo Ⅱ级肾癌合并IVC癌栓，IVC阻断或离断均有较高的出血和AKI风险，需加强多学科协作与精细化围术期管理。
Abstract:
ObjectiveTo investigate the perioperative anesthetic management and clinical outcomes of robotassisted radical nephrectomy (RARN) with inferior vena cava tumor thrombectomy (IVCTT).MethodsA retrospective analysis was performed on clinical data of 84 patients with renal cell carcinoma with Mayo grade Ⅱ inferior vena cava (IVC) tumor thrombus who underwent RARN and IVCTT at our hospital between January 2022 and December 2024. According to intraoperative IVC management method, the patients were divided into the IVC clamping group (n=55) and the IVC transection group (n=29). Perioperative parameters including operative time, pneumoperitoneum duration, blood loss, transfusion volume, vasoactive drug use, and renal function changes were compared between the two groups.ResultsThe operative time, pneumoperitoneum duration, and anesthesia time were significantly longer in the IVC clamping group than those in the IVC transection group (t=2.601, P=0.011; t=2.650, P=0.010; Z=-2.658, P=0.008). The intraoperative net fluid balance was also significantly greater in the IVC clamping group as compared with the IVC transection group (t=2.397, P=0.019). No significant differences were observed between the two groups in packed red blood cell (pRBC) transfusion rate ［63.6%(35/55) vs. 55.2%(16/29), χ2=0.570,P=0450］, plasma transfusion rate ［38.2%(21/55) vs. 34.5%(10/29), χ2=0.112,P=0.738］, and intraoperative hypotension (IOH) rate ［20.0% (11/55) and 6.9% (2/29), χ2=1.591, P=0.207］. During IVC clamping or transection, the proportion of patients requiring increased vasopressor administration was 49.1%(27/55) and 27.6%(8/29) in the respective groups, and this difference also lacked of statistical significance (χ2=3.613, P=0.057). The ALT and AST levels at postoperative day 1 were significantly higher in the IVC transection group than those in the IVC clamping group (P<0.05). The proportions of patients developing postoperative acute kidney injury (AKI) were 18.2%(10/55) and 10.3%(3/29) in the two groups, respectively, with no significant difference observed (χ2=0.892, P=0.345). Furthermore, there were no significant differences in ICU admission rates, length of ICU stay, or postoperative hospital stay between the groups (P>0.05). ConclusionsTreatment with RARN and IVCTT in patients with renal cell carcinoma and Mayo grade Ⅱ IVC tumor thrombus is associated with substantial risks of hemorrhage and AKI during IVC clamping or transection. Strengthened multidisciplinary collaboration and meticulous perioperative management are therefore essential to mitigate these complications.

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备注/Memo

备注/Memo:
基金项目：国家临床重点专科建设项目(2025年)专项资金**通讯作者，Email：liminanesth@bjmu.edu.cn①泌尿外科
更新日期/Last Update: 2026-08-06