肾细胞癌伴下腔静脉血栓形成行肾切除术时遭遇逆行性主动脉夹层——病例报告
Retrograde aortic dissection encountered amidst nephrectomy for renal cell carcinoma with IVC thrombus - a case report.
作者信息
Gali Kasi Viswanath, Rai Guruprasad D, Choudhary Anupam, Surag K R, Kamath Ganesh S, Chawla Arun, Gunashekar Vijay
机构信息
Department of Urology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Department of Cardiothoracic Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
出版信息
BMC Urol. 2024 Dec 4;24(1):264. doi: 10.1186/s12894-024-01662-x.
BACKGROUND
Management of RCC with IVC thrombus can be surgically challenging, particularly when the tumour thrombus extends above the diaphragm. Cardiopulmonary bypass is often employed to aid surgical removal of the tumour in such cases.
CASE PRESENTATION
We detail an instance of 67-year-old Male patient suffering from RCC with IVC thrombus, with the tumour thrombus extending into the right atrium, who developed on-table retrograde type A aortic dissection amidst the surgical procedure, thereby precluding cardiopulmonary bypass. Transfixation of the renal arterial stump resulted in disappearance of the dissection flap.
CONCLUSIONS
Operating surgeons should be mindful of the potential for retrograde aortic dissection during Radical Nephrectomy and its implications intraoperatively.
背景
伴有下腔静脉血栓的肾细胞癌的治疗在手术上具有挑战性，尤其是当肿瘤血栓延伸至膈肌上方时。在这种情况下，常采用体外循环辅助手术切除肿瘤。
病例介绍
我们详细描述了一例67岁男性患者，患有伴有下腔静脉血栓的肾细胞癌，肿瘤血栓延伸至右心房，在手术过程中发生了术中逆行性A型主动脉夹层，从而无法进行体外循环。肾动脉残端的贯穿缝合导致夹层瓣消失。
结论
手术医生在根治性肾切除术期间应注意逆行性主动脉夹层的可能性及其术中影响。
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