经食管超声心动图在肾癌伴下腔静脉癌栓手术治疗中的应用  

Application of Intraoperative Transesophageal Echocardiography in the Treatment of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus

作　　者：贾江华[1] 李旭泽[2] 王凤[3] 张明[1] 孟庆松[1] 马子越 汪鑫[1] JIA Jianghua;LI Xuze;WANG Feng;ZHANG Ming;MENG Qingsong;MA Ziyue;WANG Xin(Department of Urology,the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China;Department of Anesthesiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China;Department of Cardiac Ultrasound,the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第二医院泌尿外科,石家庄050031 [2]河北医科大学第二医院麻醉科,石家庄050031 [3]河北医科大学第二医院心脏超声科,石家庄050031

出　　处：《中国医学科学院学报》2023年第1期28-32,共5页Acta Academiae Medicinae Sinicae

基　　金：河北省省级科技计划(19277715D)。

摘　　要：目的探讨术中经食管超声心动图(TEE)在肾癌伴下腔静脉癌栓诊治中的应用价值。方法选取2017年1月至2021年1月在河北医科大学第二医院收治的10例肾癌伴下腔静脉癌栓患者,术中应用TEE定位癌栓位置,确定下腔静脉阻断点,统计术中癌栓脱落率、癌栓切除完整度、出血量等指标,评价TEE在肾癌伴下腔静脉癌栓手术中的应用价值。结果10例患者全部顺利完成手术,其中开放手术8例,腹腔镜手术2例。TEE显示癌栓清晰,均完整切除癌栓,术中均未发生癌栓脱落,术中平均出血量(520.0±193.2)ml(300~800 ml)。TEE发现2例术前诊断为Ⅲ级癌栓的患者降为Ⅱ级,1例术前诊断为Ⅰ级癌栓的患者升为Ⅱ级,1例术前未发现癌栓末端漂浮小癌栓的患者,经TEE辅助及时调整阻断位置,避免漂浮小癌栓脱落。结论TEE可以精确判断并动态监测下腔静脉癌栓位置及形态,为外科手术提供重要参考依据,在肾癌伴下腔静脉癌栓手术中具有重要的临床应用价值。Objective To investigate the value of intraoperative transesophageal echocardiography(TEE)in the diagnosis and treatment of renal cell carcinoma with inferior vena cava tumor thrombus.Methods Ten patients of renal cell carcinoma with inferior vena cava tumor thrombus treated in the Second Hospital of Hebei Medical University from January 2017 to January 2021 were selected.TEE was employed to locate the position of the tumor thrombus,determine the occlusion point of the inferior vena cava,count the intraoperative tumor thrombus shedding rate,examine the tumor thrombus resection integrity,and measure blood loss and other indicators,on the basis of which the application value of TEE in the operation of renal cell carcinoma with inferior vena cava tumor thrombus was evaluated.Results All the 10 patients had completed the operations successfully,including 8 patients of open operation and 2 patients of laparoscopic operation.TEE showed tumor thrombi clearly,and all the tumor thrombi were completely removed.There was no tumor thrombus shedding during the operation.The blood loss varied within the range of 300-800 ml,with the mean of(520.0±193.2)ml.The grade Ⅲ tumor thrombi in 2 patients and the grade Ⅰ tumor thrombus in 1 patient diagnosed before operation were reduced to grade Ⅱ and upgraded to grade Ⅱ,respectively,by TEE.One patient had no floating tumor thrombus at the end of tumor thrombus before operation,and the blocking position was adjusted in time with the assistance of TEE to avoid the shedding of the floating tumor thrombus.Conclusion TEE can accurately determine and dynamically monitor the location and shape of inferior vena cava tumor thrombus,which provides an important reference and has a significant clinical value in the operation of renal cell carcinoma with inferior vena cava tumor thrombus.

关 键 词：经食管超声心动图 肾癌 静脉癌栓 漂浮癌栓 癌栓切除术 

分 类 号：R699.2[医药卫生—泌尿科学]