肾癌伴下腔静脉癌栓手术患者麻醉管理的回顾性分析  

Retrospective analysis of anesthesia management in patients with renal cell carcinoma complicated with tumor thrombus in inferior vena cava

作　　者：王怡 朱政 王永徽 付静文 朱正华 路志红 范倩倩 WANG Yi;ZHU Zheng;WANG Yonghui;FU Jingwen;ZHU Zhenghua;LU Zhihong;FAN Qianqian(Department of Anesthesiology and Perioperative Medicine;Department of Urology,Xijing Hospital,Air Force Medical University,Shaanxi Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院麻醉与围术期医学科 [2]空军军医大学西京医院泌尿外科,陕西西安710032

出　　处：《现代肿瘤医学》2025年第4期653-659,共7页Journal of Modern Oncology

摘　　要：目的:总结肾癌伴下腔静脉癌栓手术患者麻醉管理要点,并对比分析下腔静脉癌栓Mayo分级Ⅰ-Ⅱ级与Ⅲ-Ⅳ级患者术中严重不良事件发生率。方法:回顾性分析2012年01月至2024年03月在本院行“肾癌根治性切除,下腔静脉癌栓取出术”患者的临床资料,包括患者基本情况、麻醉管理策略及术中严重不良事件发生情况等。结果:共43例患者纳入研究,年龄41~81岁,下腔静脉癌栓Mayo分级Ⅰ级9例、Ⅱ级27例、Ⅲ级6例、Ⅳ级1例。术中严重不良事件发生率为大失血30.2%,循环不稳定事件32.6%,心律失常11.6%,急性心衰9.3%,肺栓塞4.7%,术中心跳呼吸骤停2.3%。与Mayo分级Ⅰ-Ⅱ级患者相比,Ⅲ-Ⅳ级患者术中出血量和大失血发生率明显增加,差异有统计学意义(P<0.05)。与术前基础值相比,术后1天血肌酐、谷丙转氨酶和谷草转氨酶水平显著升高,差异有统计学意义(P<0.05)。结论:肾癌伴下腔静脉癌栓手术患者术中大出血及严重心血管不良事件发生率高,Mayo分级Ⅲ-Ⅳ级与Ⅰ-Ⅱ级患者相比术中出血量和大失血发生率明显增加,麻醉医生应进行完善的术前评估和准备,了解手术进程并熟练掌握肺栓塞等严重并发症的识别、诊断和处理方法,同时密切关注重要脏器功能保护。Objective:To summarize the key points of anesthesia management for patients who underwent nephrectomy with inferior vena cava thrombectomy,and compare the incidences of severe intraoperative adverse events between patients with Mayo gradeⅠ-Ⅱand gradeⅢ-Ⅳinferior vena cava tumor thrombus.Methods:A retrospective analysis was performed on the clinical data of patients who underwent nephrectomy with inferior vena cava thrombectomy in our hospital from January 2012 to March 2024.Patients'basic information,anesthesia management strategies,and the occurrence of intraoperative serious adverse events were recorded.Results:A total of 43 patients were included in this study,aged 41~81 years,with 9 cases of Mayo gradeⅠ,27 cases of Mayo gradeⅡ,6 cases of Mayo gradeⅢ,and 1 case of Mayo gradeⅣfor inferior vena cava tumor thrombus.The incidences of intraoperative adverse events were 30.2%for massive hemorrhage,32.6%for circulatory instability,11.6%for arrhythmia,9.3%for acute heart failure,4.7%for pulmonary embolism,and 2.3%for intraoperative cardiac arrest and respiratory arrest.Compared to patients with Mayo gradeⅠ-Ⅱ,those with gradeⅢ-Ⅳhad significantly increased intraoperative blood loss and a higher incidence of massive hemorrhage(P<0.05).Compared with baseline values,the serum levels of creatinine,alanine aminotransferase,and aspartate aminotransferase on postoperative day 1 were significantly increased(P<0.05).Conclusion:Patients undergoing nephrectomy with inferior vena cava thrombectomy have a high incidence of intraoperative massive hemorrhage and severe cardiovascular adverse events.The intraoperative blood loss and the incidence of massive hemorrhage significantly increase in Mayo gradeⅢ-Ⅳpatients compared to those in Mayo gradeⅠ-Ⅱ.It is essential for anesthesiologists to conduct a comprehensive preoperative assessment and preparation,understand the surgical process,and be proficient in identifying,diagnosing,and managing severe complications such as pulmonary embolism.At the same time,c

关 键 词：肾癌 下腔静脉 癌栓 麻醉 

分 类 号：R737.11[医药卫生—肿瘤]