Escudero A, Flo A, Espí C, Moret E, Massó E, Cubells C
Servicio de Anestesiología y Reanimación, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona.
Rev Esp Anestesiol Reanim. 2006 Jun-Jul;53(6):378-82.
Renal tumors can be associated with a thrombus that affects the renal vein and even the inferior vena cava. Radical surgery may require a 2-phase approach involving different anesthetic techniques: an abdominal approach for removal of the kidney and a thoracic approach for extraction of the thrombus, with extracorporeal circulation and in some cases cessation of blood circulation. We present 2 cases in which nephrectomy and thrombectomy were carried out with the support of extracorporeal circulation. The thrombus was in the renal vein and the inferior vena cava, extending to the outlet to the right atrium in both cases. In 1 case a portion reached the bifurcation of the pulmonary artery. The operation was performed under hypothermia to reduce circulation and did not require aortic clamping, cardioplegia, or cessation of blood flow.
肾肿瘤可能与影响肾静脉甚至下腔静脉的血栓有关。根治性手术可能需要分两阶段进行，采用不同的麻醉技术：经腹部途径切除肾脏，经胸部途径取出血栓，需体外循环，某些情况下还需停止血液循环。我们报告2例在体外循环支持下进行肾切除术和血栓切除术的病例。两例患者的血栓均位于肾静脉和下腔静脉，并延伸至右心房出口。其中1例血栓部分延伸至肺动脉分叉处。手术在低温下进行以减少循环，无需主动脉阻断、心脏停搏或血流停止。
