Kamiya T, Nakagawa I, Kubota M, Niinai H, Unetani H
Department of Anesthesia, Yoshida General Hospital, Hiroshima.
Masui. 1998 Aug;47(8):978-81.
We gave anesthesia to a patient with a right kidney tumor associated with complete occlusion of the inferior vena cava (IVC) by tumor embolism. The upper end of the tumor embolism was below the junction of the IVC and the hepatic vein, and the operation was considered possible by simply clamping the IVC. To prevent complications including pulmonary embolism, the circulatory change at the time of clamping of the IVC, and massive bleeding, monitoring was made by pulmonary artery catheter and transesophageal echocardiography, and extracorporeal circulation was prepared. The blood pressure was stable and massive bleeding did not occur at the time of clamping of the IVC, because the IVC was completely occluded. The monitor showed no signs of pulmonary embolism. In a case of kidney tumor with tumor embolism in the IVC, it is necessary to be fully prepared for pulmonary embolism, the change of blood pressure before and after clamping of the IVC and for the bleeding at the time of IVC excision.
我们为一名患有右肾肿瘤且肿瘤栓子导致下腔静脉（IVC）完全闭塞的患者实施麻醉。肿瘤栓子的上端位于IVC与肝静脉交界处下方，认为通过简单钳夹IVC即可进行手术。为预防包括肺栓塞、钳夹IVC时的循环变化以及大出血等并发症，采用肺动脉导管和经食管超声心动图进行监测，并准备好体外循环。由于IVC完全闭塞，钳夹IVC时血压稳定且未发生大出血。监测未显示肺栓塞迹象。对于患有IVC肿瘤栓子的肾肿瘤病例，有必要为肺栓塞、钳夹IVC前后的血压变化以及IVC切除时的出血做好充分准备。
