体外循环与非体外循环辅助下肾癌合并Ⅲ、Ⅳ级下腔静脉癌栓手术治疗效果比较

Surgical comparison of renal cell carcinoma with Ⅲ, Ⅳ tumor thrombus in inferior vena cava with or without the aid of cardiopulmonary bypass

目的 探讨体外循环与非体外循环辅助下肾癌合并Ⅲ、Ⅳ级下腔静脉癌栓形成手术治疗效果.方法 遵循随机对照的方法,将肾癌合并Ⅲ、Ⅳ级下腔静脉（IVC）癌栓患者随机分为两组,体外循环（CPB）辅助下手术治疗11例,同期按照非CPB辅助手术治疗11例.两种术式患者年龄、性别、患侧、肿瘤大小,及癌栓分级等差异均无统计学意义.通过统计分析手术时间、术中出血量、术中输血量、术后引流管拔除时间、术后意识恢复时间、术后住院时间及并发症,比较两种术式的手术效果.结果 22例手术均获成功,无术中改变术式者.CPB组与非CPB组的手术时间分别为（468.2±45.1） min和（440.4±52.5）min,术后意识恢复时间分别为（2.5±1.6）h和（1.5±0.7）h,差异均无统计学意义（P＞0.05）;术中出血量分别为（2 654.6±1 142.3）ml和（3751.6±1 072.4） ml,术中输血量分别为（1 986.2±942.7）ml和（3 147.1 ± 997.3）ml术后腹腔引流管拔除时间分别为（3.2±1.4）d和（4.5±1.3）d,术后住院时间分别为（10.5±1.3）d和（12.6±1.9）d,差异均有统计学意义（P＜0.05）.CPB组1例患者出现凝血功能障碍,给予口服华法林后恢复正常.非CPB组1例患者术后出现肝功能损伤,给予保肝治疗后恢复,2例术后出现切口延迟愈合,给予定期换药后愈合.结论 CPB辅助下手术治疗肾癌合并Ⅲ、Ⅳ级IVC癌栓与非CPB辅助手术比具有出血量小、并发症少、住院时间短等优点.

Objective To explore the surgical treatment of renal cell carcinoma with Ⅲ,Ⅳ tumor thrombus in inferior vena cava （IVC） with or without the aid of cardiopulmonary bypass （CPB）.Methods Following the randomized controlled experiment method,the patients were randomly divided into two groups：CPB-assisted surgical treatment of 11 cases,and 11 cases over the same period in accordance with the non-CPB assisted surgery.There were no significant differences in patients＇ characteristics,including age,gender,side primary tumor stage,tumor size and thrombus levels.Through the statistical analysis of the operation time,estimated blood loss,intraoperative blood transfusions,postoperative hospital stays and perioperative complications,the effects of two surgical procedures were compared.Results Twenty-two cases were operatated successfully,and no intraoperative surgical procedures were converted.The mean operation time [（468.2 ±45.1） min vs.（440.4 ± 52.5） min],and the mean recovery time after surgery consciousness [（2.5 ± 1.6） h vs.（1.5 ± 0.7） h],showed no significant difference between the two groups （P〉 0.05）.The estimated blood loss [（2654.6± 1 142.3）mlvs.3751.6± 1 072.4） ml],intraoperative blood transfusions [（1 986.2 ± 942.7） ml vs.（3 147.1 ± 997.3） ml],the duration of the drainage [（3.2 ± 1.4） d vs.（4.5 ± 1.3） d],and postoperative hospital stays [（10.5 ± 1.3） d vs.（12.6 ± 1.9） d] showed significant difference between CPB group and non-CPB group （P 〈 0.05）.One case in CPB group had coagulopathy,and after oral administration of warfarin the patient recovered.One case in non-CPB group had liver injury,the treatment was given to protect the liver and the patient recovered.Two cases had postoperative delayed wound healing,regular dressing was given,and the wounds healed.Conclusion CPB-assisted surgery for renal cell carcinoma with Ⅲ,Ⅳ tumor thrombus in IVC had the advantages of less blood loss,less complications and shorter hospital stay over the non-CPB assisted surgery.