CAJ | 학술논문

本院2010年3月至2013年12月在经食管超声心动图(TEE)术中监测下完成了6例累及右心的下腔静脉瘤栓切除术.6例患者术前检查均显示下腔静脉瘤栓延伸至右心.麻醉诱导后TEE发现,其中3例与术前检查结果有差别,故调整外科决策,决定不使用体外循环,在TEE密切监测下切开下腔静脉完整取出瘤栓.另3例患者TEE结果与术前类似,在体外循环下行瘤栓切除术.根据TEE结果,调整麻醉管理,特别是血流动力学管理方案,调整容量以及血管活性药的使用.手术切除后TEE检查均未见残余瘤栓,但是在3例右心严重受累患者均观察到重度三尖瓣返流.术后随访未见TEE使用相关并发症.本文总结报道了TEE在累及右心的下腔静脉瘤栓切除术中的应用,TEE提供的信息可纠正、优化外科决策和麻醉管理,评估手术效果,具有重要的临床应用价值.
본원2010년3월지2013년12월재경식관초성심동도(TEE)술중감측하완성료6례루급우심적하강정맥류전절제술.6례환자술전검사균현시하강정맥류전연신지우심.마취유도후TEE발현,기중3례여술전검사결과유차별,고조정외과결책,결정불사용체외순배,재TEE밀절감측하절개하강정맥완정취출류전.령3례환자TEE결과여술전유사,재체외순배하행류전절제술.근거TEE결과,조정마취관리,특별시혈류동역학관리방안,조정용량이급혈관활성약적사용.수술절제후TEE검사균미견잔여류전,단시재3례우심엄중수루환자균관찰도중도삼첨판반류.술후수방미견TEE사용상관병발증.본문총결보도료TEE재루급우심적하강정맥류전절제술중적응용,TEE제공적신식가규정、우화외과결책화마취관리,평고수술효과,구유중요적림상응용개치.
Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon,which proliferates fast and could be very challenging to the surgery.This paper was designed to investigate the clinical value of transesophageal echocardiography (TEE) for the surgical resection of IVC tumor thrombus extending into right cardiac cavities.Six cases from our medical institute,preoperatively diagnosed as IVC tumor thrombus with cardiac extension and scheduled for the surgical resection,were retrospectively analyzed.In addition to real-time and dynamic monitoring,comprehensive TEE exams were performed for all the patients respectively after anesthesia induction,namely before tumor resection and after tumor resection.Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor thrombus by transthoracic echocardiography,computerized tomography or CT angiography.In all the cases,intraoperative TEE provided an accurate and excellent view of the IVC tumor thrombus.For case three,the IVC tumor thrombus was found at the IVC entrance to right atrium without further cardiac extension; for case five,the IVC tumor thrombus proliferated into right atrium but the extended cardiac mass was very slim and flexible and the tricuspid valve was untouched; for case four,the IVC tumor thrombus extended into right atrium and even cross the tricuspid valve but the extended cardiac mass was also very slim and flexible.Based on the TEE-provided information,the originally scheduled surgical decision was modified and the surgical resection was performed without cardiopulmonary bypass (CPB).For the other three cases,the intraoperative TEE showed similar results to preoperative findings.The huge IVC tumor thrombus extended into the right heart,presented almost no flexibility and dramatically compromised the intracardiac blood flow.For the three cases,CPB support was indispensable for the tumor resection.The full TEE exam after tumor resection in all the six patients displayed clear surgical resection without tumor residuals,but in those three patients suffered with severely compromised cardiac extension,severe tricuspid regurgitation was noticed.All the six patients were closely monitored until discharged,and no TEE-related complications were observed.This paper reports about TEE' s utilization in a series of consecutive patients undergoing surgical resection of IVC tumor thrombus with cardiac extension.In addition to its safety and effectiveness,TEE can provide valuable information for surgical decision making,surgical intervention assessment and anesthesiamanagement strategies.