摘要
目的探讨机器人辅助经心包膈上下腔静脉阻断切开取栓术治疗下腔静脉Ⅳa级癌栓的可行性及安全性。方法回顾性分析2013年1月至2019年6月收治的4例接受机器人辅助经心包膈上下腔静脉阻断切开取栓术治疗肾癌伴Ⅳa级癌栓患者的临床资料。4例均为男性,中位年龄53.5(53~70)岁;平均体质指数23.25(20.7~26.3)kg/m^(2)。4例因腰痛和(或)血尿就诊。肿瘤位于右侧2例,左侧2例;肿瘤平均最大径8.1(3.6~11.2)cm。所有患者术前均经彩色多普勒超声、CT三维重建和(或)MRI检查,明确癌栓分级均为Ⅳa级(膈肌以上,心房以下)。术前平均腔静脉癌栓长度12.3(11.8~18.0)cm。4例手术均在泌尿外科、肝胆外科、心血管外科、超声科及麻醉科医生团队配合下完成。手术方法:机器人辅助翻肝暴露肝后段下腔静脉;在术中超声引导下,解剖膈肌中心腱和心包,直至暴露膈上心包内下腔静脉和右心房;依次阻断第一肝门和下腔静脉;行腔静脉切开取栓及下腔静脉重建。观察围手术期指标及并发症情况。结果4例手术均顺利完成。手术时间中位值553.5(338~642)min,第一肝门阻断时间中位值18.1(14~32)min;失血量中位值1900(1000~2600)ml。所有患者术后均转入重症监护室(ICU),ICU住院时间中位值7(4~8)d,术后引流管留置时间中位值为8(4~12)d。术后平均住院时间13(11~20)d。术后并发症Clavien分级Ⅱ级1例,Ⅲ级3例;其中1例阵发性室上性心动过速,1例淋巴瘘,1例胸腔积液伴肺不张,1例肝肾功能不全及淋巴瘘。并发症经对症治疗后均有所好转。无围手术期死亡病例。结论机器人辅助经心包膈上下腔静脉阻断切开取栓术是治疗肾肿瘤伴Ⅳa级下腔静脉癌栓的一种可选择的方法,该术式可免体外循环、免开胸,手术并发症在可控范围内,无围手术期死亡病例,该术式安全、可行。
Objective To explore the feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment ofⅣa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods The clinical data of 4 patients with renal cell carcinoma andⅣa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed.The median age was 53.5(53-70)years.The average body mass index was 23.25(20.7-26.3)kg/m^(2).The tumors were located on the right side in 2 cases.The average maximum diameter of the tumor was 8.1(3.6-11.2)cm.Preoperative tumor thrombus of all patients was classified asⅣa.The average preoperative length of tumor thrombus in vena cava was 12.3(11.8-18.0)cm.All the operations were performed under multidisciplinary cooperation of urology,hepatobiliary,cardiovascular,ultrasound and anesthesiologist team.Surgical procedure:Robot assisted liver mobilization was used to expose the inferior vena cava.Under the guidance of intraoperative ultrasound,the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed.The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed.Results All the operations were completed without conversion.The median operation time was 553.5(338-642)minutes,and the median time of the first porta hepatis occlusion was 18.1(14-32)minutes.The median blood loss was 1900(1000-2600)ml.All patients were transferred to ICU after operation.The median length of stay in ICU was 7(4-8)days,and the median time of indwelling drainage tube was 8(4-12)days.The average postoperative hospital stay was 13(11-20)days.There were 1 case of gradeⅡand 3 cases of gradeⅢcomplications(Clavien classification).One case had paroxysmal supraventricular tachycardia,one c
作者
刘侃
黄庆波
彭程
喻垚
杜松良
俞鸿凯
赵国栋
刘荣
肖苍松
李双磊
李秋洋
王海屹
王保军
马鑫
张旭
Liu Kan;Huang Qingbo;Peng Cheng;Yu Yao;Du Songliang;Yu Hongkai;Zhao Guodong;Liu Rong;Xiao Cangsong;Li Shuanglei;Li Qiuyang;Wang Haiyi;Wang Baojun;Ma Xin;Zhang Xu(Department of Urology,Third Medical Center,General Hospital of the PLA,100039 Beijing,China;Medical College of Nankai University,Tianjin 30007,China;Department of Hepatobiliary Surgery,First Medical Center,General Hospital of the PLA,Beijing 100853,China;Department of Cardiovascular Surgery,Sixth Medical Center,General Hospital of the PLA,Beijing 100142,China;Department of Altrasound Diagnosis,First Medical Center,General Hospital of the PLA,Beijing 100853,China;Department of Imaging Diagnosis,First Medical Center,General Hospital of the PLA,Beijing 100853,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第7期502-506,共5页
Chinese Journal of Urology
基金
国家自然科学基金面上项目(81970665,81970594)。
关键词
肾肿瘤
机器人
腹腔镜
下腔静脉癌栓
体外循环
Kidney neoplasms
Robot
Laparoscopy
Inferior vena cava tumor thrombus
Cardiopulmonary bypass
