体外循环血液回收在肾癌并III型下腔静脉癌栓根治手术中的作用

Blood Recovery Technology in Cardiopulmonary Bypass for Renal Cell Carcinoma(RCC) Complicated with Type III Tumor Thrombi of Inferior Vena Cava,Undergoing Nephrectomy and Thrombectomy

目的探讨体外循环血液回收辅助下肾癌合并Ⅲ型下腔静脉（inferiorvenaCaVa，IVc）癌栓患者的手术方法及治疗效果。方法在体外循环血液回收辅助下为24例肾癌并Ⅲ型IVC癌栓的患者实施了肾癌切除IVC切开取栓手术。结果所有手术均获成功，无肺栓塞和急性肾功能衰竭。术中出血量200-1200mL，平均540mL；术中术后输红细胞0-8u，平均4U，输血浆0-800mL，平均233mL。21例术后随访5—60个月，无瘤生存5年以上9例，生存1—3年12例，另3例失访。结论体外循环血液回收辅助下根治肾癌伴Ⅲ型Ⅳc癌栓安全可行的，应用体外循环血液回收可减少术中出血及术后输血量。

Objective To discuss the operation methods of treating 24 cases of RCC complicated with type Ⅲ tumor thrombi of IVC, assisted with blood recovery technology in cardiopulmonary bypass and the treatment effect. Methods The clinical data of 24 patients with RCC complicated with tumor thrombi of IVC underwent nephrectomy and thrombectomy, assisted with blood recov- ery technology in cardiopulmonary bypass, were retrospectively analyzed. Results All the operations were successful. No pul- monary embolism or acute renal failure. The blood loss in operation was 200-1 200 mL ,average 540 mL;blood-transfusion in and after operation ：RCC 0-8 U,average 4 U; FFP 0-800 mL,average 233 mL. 21 patients were followed up for 5-60 months after surgery. Of whom, 9 patients survived longer than 5 years, 12 patients survived for 1 to 3 years. 3 patients lost to follow-up. Conclusion Blood recovery technology in cardiopulmonary bypass for RCC complicated with typeⅢ tumor thrombi is safe and feasible, and it can reduce the intraoperative blood loss and postoperative blood transfusion.