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| 机器人辅助肾癌合并Ⅲ或Ⅳ级下腔静脉瘤栓切除术的早期预后 |
| Early prognosis of robot-assisted thrombectomy for level Ⅲ or Ⅳ inferior vena cavathrombus with renal carcinoma |
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| DOI：10.12089/jca.2022.03.005 |
| 中文关键词: 下腔静脉 肾肿瘤 瘤栓 肝功能 肾功能 缺血-再灌注损伤 |
| 英文关键词: Inferior vena cava Renal tumor Tumor thrombus Hepatic function Nephritic function Ischemia-reperfusion injury |
| 基金项目:国家重点研发计划（2018YFC2001900） |
| 作者 | 单位 | E-mail | | 许喆 | 100853,北京市,中国人民解放军总医院第一医学中心麻醉科 | | | 陈岗 | 100853,北京市,中国人民解放军总医院第一医学中心麻醉科 | | | 宋玉祥 | 100853,北京市,中国人民解放军总医院第一医学中心麻醉科 | | | 史宜正 | 100853,北京市,中国人民解放军总医院第一医学中心麻醉科 | | | 薛丁豪 | 100853,北京市,中国人民解放军总医院第一医学中心麻醉科 | | | 傅强 | 100853,北京市,中国人民解放军总医院第一医学中心麻醉科 | dr_fuqiang@hotmail.com |
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| 中文摘要: |
目的 分析机器人辅助肾癌合并Ⅲ或Ⅳ级下腔静脉瘤栓（IVCTT）切除术患者术后的肾功能、肝功能、凝血功能和Hb的变化。
方法 选择机器人辅助肾癌合并Ⅲ或 Ⅳ级IVCTT切除术患者18例，男15例，女3例，年龄27~71岁，BMI 18~29 kg/m2，ASA Ⅱ或Ⅲ级。根据Mayo分级分为两组：Ⅲ级IVCTT组（L3组，n=6）和Ⅳ级IVCTT组（L4组，n=12）。L3组为Ⅲ级IVCTT；L4组为Ⅳ级IVCTT。记录术前1 d、术后1、3、5、7 d血肌酐（Cr）、尿素氮（BUN）、总胆红素（TBIL）、ALT、国际标准化比值（INR）和Hb。记录总液体、晶体、胶体输注量，总失液量、总失血量、总尿量和去氧肾上腺素、去甲肾上腺素用量。记录手术时间、麻醉时间、术后住院时间，术后输血、感染和血栓情况。
结果 与术前1 d比较，L3组术后3 d、L4组术后3、5、7 d Cr明显升高(P<0.05)，L3组术后3、5、7 d、L4组术后1、3、5、7 d BUN明显升高(P <0.05)，两组术后1 d TBIL、ALT、INR明显升高(P<0.05)，L4组术后3、5、7 d Hb明显降低(P<0.05)。两组不同时点Cr、BUN、TBIL、ALT、INR和Hb差异均无统计学意义。两组总液体、晶体、胶体输注量，总失液量、总失血量、总尿量和去氧肾上腺素、去甲肾上腺素用量差异无统计学意义。L4组手术时间和麻醉时间明显长于L3组（P<0.05），两组术后住院时间，术后输血、感染和血栓情况差异无统计学意义。
结论 机器人辅助肾癌合并Ⅲ或Ⅳ级IVCTT切除术是一种高风险手术。除了术中大出血和瘤栓脱落的风险外，围术期肝肾功能的维持和血液保护对改善患者早期预后十分重要。 |
| 英文摘要: |
Objective To analyze the changes of renal function, hepatic function, coagulation function and Hb after robot-assisted thrombectomy in renal carcinoma patients with level Ⅲ or Ⅳ inferior vena cava thrombus(IVCTT).
Methods Eighteen patients with renal carcinoma complicated with level Ⅲ or Ⅳ IVCTT were selected, including 15 males and 3 females, aged 27-71 years, BMI 18-29 kg/m2, ASA physical status Ⅱ or Ⅲ. According to Mayo classification, the patients were divided into two groups: level Ⅲ IVCTT group (group L3， n = 6) and level Ⅳ IVCTT group (group L4， n = 12). Group L3 was level Ⅲ IVCTT; group L4 was level Ⅳ IVCTT. Serum creatinine (Cr), urea nitrogen (BUN), total bilirubin (TBIL), ALT, international standardized ratio (INR) and Hb were collected 1 day before surgery and 1, 3, 5 and 7 days after surgery. Total fluid, crystal, colloid infusion, total fluid loss, total blood loss, total urine volume and dosage of phenylephrine and norepinephrine were collected. Operation time, anesthesia time, postoperative hospital stay, postoperative blood transfusion, infection and thrombosis were also recorded.
Results Compared with 1 day before operation, Cr in group L3 3 days after operation and group L4 3, 5, and 7 days after operation was significantly increased (P < 0.05). BUN was significantly increased 3, 5, 7 days after operation in group L3 and 1, 3, 5, 7 days after operation in group L4 (P < 0.05). TBIL, ALT and INR were significantly increased 1 day after operation in the two groups (P < 0.05), Hb in group L4 was significantly decreased 3, 5 and 7 days after operation (P < 0.05). There were no significant differences in Cr, BUN, TBIL, ALT, INR and Hb between the two groups at different time points. There were no significant differences in the total fluid, crystalloid, colloid infusion volume, total fluid loss, total blood loss, total urine volume, and the dosage of phenylephrine and norepinephrine between the two groups. The operation time and anesthesia time in group L4 were significantly longer than those in group L3 (P < 0.05). There was no significant difference in the postoperative hospital stay, postoperative blood transfusion, infection and thrombosis between the two groups.
Conclusion Robot-assisted thrombectomy for level Ⅲ or Ⅳ IVCTT with renal cell carcinoma is a highly risky procedure. On top of the risk of intraoperative bleeding and tumor thrombus shedding, maintenance of perioperative liver and kidney function and blood protection are very important to improve the early prognosis of patients. |
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