中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2014年
12期
1140-1143
,共4页
后腹腔镜%肾癌根治术%癌栓取出术%麻醉管理
後腹腔鏡%腎癌根治術%癌栓取齣術%痳醉管理
후복강경%신암근치술%암전취출술%마취관리
Retroperitoneoscopy%Nephrectomy%Thrombectomy%Anesthetic management
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。
目的：探討後腹腔鏡腎癌根治性切除併下腔靜脈癌栓取齣術的痳醉管理要點。方法迴顧性分析2010年12月～2014年6月3例後腹腔鏡腎癌併下腔靜脈癌栓根治術患者的圍術期臨床資料。Ⅰ型癌栓2例，Ⅱ型癌栓1例。氣管插管全身痳醉，Ⅱ型癌栓術中行短暫下腔靜脈阻斷。結果3例均順利完成取栓，無中轉開腹，手術時間244、333、289 min，1例下腔靜脈完全阻斷時間10 min，術中均未髮生肺栓塞及其他嚴重痳醉併髮癥。1例術後拔管返迴普通病房，2例轉入ICU後24 h內拔氣管導管併轉迴普通病房。結論後腹腔鏡腎癌根治性切除併下腔靜脈癌栓取齣術是新型、高危但可行的手術方式，痳醉醫師應噹熟知具體手術操作步驟，以製定相關痳醉計劃併密切配閤，密切關註下腔靜脈阻斷期間循環波動，嚴防大齣血、肺栓塞等嚴重併髮癥的髮生。
목적：탐토후복강경신암근치성절제병하강정맥암전취출술적마취관리요점。방법회고성분석2010년12월～2014년6월3례후복강경신암병하강정맥암전근치술환자적위술기림상자료。Ⅰ형암전2례，Ⅱ형암전1례。기관삽관전신마취，Ⅱ형암전술중행단잠하강정맥조단。결과3례균순리완성취전，무중전개복，수술시간244、333、289 min，1례하강정맥완전조단시간10 min，술중균미발생폐전새급기타엄중마취병발증。1례술후발관반회보통병방，2례전입ICU후24 h내발기관도관병전회보통병방。결론후복강경신암근치성절제병하강정맥암전취출술시신형、고위단가행적수술방식，마취의사응당숙지구체수술조작보취，이제정상관마취계화병밀절배합，밀절관주하강정맥조단기간순배파동，엄방대출혈、폐전새등엄중병발증적발생。
Objective To evaluate the key points of anesthetic management for retroperitoneoscopic nephrectomy combined with inferior vena cava ( IVC ) tumor thrombectomy. Methods Perioperative 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 Ⅰthrombus and 1 case of level Ⅱthrombus.All the patients were given general anesthesia with intubation.Brief inferior vena cava occlusion was performed in the patient with level Ⅱ thrombus. Results The 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 ⅠIVC 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 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.
