中度低温与脑灌注下的 Wilms 瘤伴心房延伸切除术。
Excision of Wilms' Tumor With Atrial Extension Under Moderate Hypothermia and Cerebral Perfusion.
机构信息
Department of Adult and Child Cardiovascular Surgery and Heart Transplantation, Louis Pradel Cardiologic Hospital, Bron, France;
Department of Urology, Visceral, Thoracic and Transplant Surgery, Woman-Mother-Child Hospital, Bron, France.
出版信息
In Vivo. 2021 Jul-Aug;35(4):2213-2216. doi: 10.21873/invivo.12493.
BACKGROUND
Wilms' tumor is the most common pediatric renal tumor. Almost half of all cases have involvement of the inferior vena cava, which must be addressed at the time of surgical excision. Further extension into the right atrium may pose an immediate vital risk and necessitates special operative techniques that employ cardiopulmonary bypass.
CASE REPORT
We report the case of a child with a left Wilms' tumor with inferior caval and right atrial involvement, which led to significant hemodynamic compromise and urgent surgery. A left nephrectomy and cavoatrial thrombectomy were performed via a sterno-laparotomy. Our strategy employed moderate hypothermic circulatory arrest at 26°C and antegrade cerebral perfusion in order to improve visualization and ensure complete thrombectomy and protection of the abdominal organs.
CONCLUSION
This case emphasizes the advantages of moderate hypothermic circulatory arrest compared to deep hypothermic circulatory arrest and normothemic cardiopulmonary bypass.
背景
肾母细胞瘤是最常见的儿童肾肿瘤。几乎一半的病例都涉及下腔静脉，在下腔静脉必须在手术切除时处理。进一步延伸到右心房可能会立即危及生命，需要采用体外循环的特殊手术技术。
病例报告
我们报告了一例左肾母细胞瘤伴下腔静脉和右心房受累的病例，这导致了严重的血液动力学障碍，并需要紧急手术。通过胸骨剖腹术进行了左肾切除术和腔静脉血栓切除术。我们的策略是在 26°C 下采用中度低温循环停止和顺行脑灌注，以改善可视化并确保完全血栓切除术和腹部器官的保护。
结论
本病例强调了中度低温循环停止相对于深低温循环停止和常温体外循环的优势。
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