深低温停循环下右肾癌切除及下腔静脉癌栓取出术

目的 探讨深低温停循环下右肾癌根治及下腔静脉癌栓(肝上型)取出术方法的可行性.方法1例50岁女性右肾癌伴下腔静脉及右心房癌栓患者行深低温停循环下右肾癌根治及下腔静脉血栓取出术.取胸腹联合正中切口,探查腹腔后,显露右肾、下腔静脉及右肾肾蒂结构.全身肝素化后行升主动脉、上腔静脉、主动脉根部、右上肺静脉插管.经体外循环机降温,降至20℃时停止体外循环.于右肾静脉入口处切开下腔静脉,经下腔静脉插入16 F导管至右心房,充盈气囊,向下拖出癌栓同时切除右肾.缝合下腔静脉切口,恢复体外循环并复温.结果 手术时间330 min,术中生命体征平稳,体外循环时间90 min,深低温停循环时间20 min.术中失血400 ml,输浓缩红细胞6U(机器填充用)及血浆600 ml.患者术后150 min清醒,4 d进食并下床活动,10 d出院.随访6个月未见复发或转移.结论 深低温心脏停搏技术可提高肾癌合并肝上型下腔静脉癌栓手术的有效性和安全性.

Nephrectomy and removal of inferior vena cava tumor thrombus under profound hypothermia and arrested circulation

Objective To study the feasibility and safety of performing nephrectomy together with the removal of complicated inferior vena cava tumor thrombus under profound hypothermia and arrested circulation. Methods After made the median thoraco-abdominal incision, the exploration of the abdominal organs was done. The right kidney, inferior vena cava and renal pedicle were well exposed then. After the whole body heparinization, cannulas were put into ascending aorta, superior vena cava, aortic root and right superior pulmonary vein. The body temperature was reduced to 20℃ with cardiopulmonary bypass unit and the extracorporeal circulation was stopped then. Cut open the inferior vena cava at vena renalis dextra ingress and the F16 urinary catheter was inserted into atrum dextra through inferior vena cava and inflated. The tumor thrombus was pulled out and the right kidney was removed. The inferior vena cava incision was sutured to close and the extracorporeal circulation was resumed and patient was re-warmed.Results The operation time was 330 min and the extracorporeal circulation time was 90 min, while the profound hypothermia with circulatory arrest time was 20 min. The estimated blood loss during operation was 400 ml and 6 unit red cells and 600 ml blood plasm were transfused. The patient was awaked 2.5 h after the operation, food intake resumed 4 days after operation and the patient was discharged on day 10 post-operatively. After 6 months'follow-up, there were no local recurrence and metastasis occurred. Conclusion The technique of profound hypothermia and circulation arrest could improve the safety and efficacy in the treatment of renal cell carcinoma with suprahepatic (level Ⅲ) caval tumor thrombus.