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

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月一2014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、289rain，1例下腔静脉完全阻断时间10rain，术中均未发生肺栓塞及其他严重麻醉并发症。l例术后拔管返回普通病房，2例转入ICU后24h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。

Anesthetic Management for Retroperitoneoscopic Nephrectomy Combined with Inferior Vena Cava Tumor Thrombectomy

Objective To evaluate the key points of anesthetic management for retroperitoneoscopic nephrectomy combined with inferior vena eava （IVC） tumor thrombectomy. Methods Perioperative clinical data of 3 patients undergoing retroperitoneoscopic nephreetomy combined with 1VC tumor thrombectomy from December 2010 to June 2014 were retrospectively analyzed. There were 2 cases of level ] thrombus and 1 case of level ]] thrombus. All the patients were given general anesthesia with intubation. Brief inferior vena cava occlusion was performed in the patient with level I[ thrombus. Results The operation was completed smoothly in all the cases without conversions to open surgery. The operating time was 244, 333, and 289 rain, respectively. The total IVC control time for level II thrombus was 10 vain. 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. Conclusions Retroperitoneoscopic nephreetomy and IVC thrombeetomy 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 cmbolization and massive hemorrhage cannot be neglected.