机器人辅助腹腔镜下根治性肾切除联合下腔静脉瘤栓取出术的临床麻醉研究

Clinical study on the anesthesia for robot assisted laparoscopic nephrectomy with inferior vena caval thrombectomy

目的探讨机器人辅助腹腔镜下根治性肾切除联合下腔静脉瘤栓取出术麻醉管理的安全性和可行性。方法回顾性分析2013年5月至2016年2月解放军总医院收治的25例肾癌伴下腔静脉瘤栓患者的临床资料。男21例,女4例,年龄42~81岁。分析患者术中血流动力学、动脉血气分析、术后清醒时间及术后转归情况。结果除1例患者因3次手术史,探查后发现严重粘连无法分离组织放弃手术外,其余24例均顺利完成机器人辅助腹腔镜下根治性肾切除联合下腔静脉瘤栓取出术。与阻断前即刻比较,阻断后3 min中心静脉压（CVP）和平均动脉压（MAP）降低,心率及每搏量变异度（SVV）升高,开放后即刻动脉血p H、剩余碱（BE）值降低,差异均有统计学意义（P〈0.05）;除1例患者带气管导管回重症监护室外,其余23例患者停止麻醉药物至清醒拔出气管导管的时间为（25±6）min,术后转回普通病房;所有病例术中、术后无严重并发症,无疾病进展及死亡病例。结论机器人辅助腹腔镜下根治性肾切除联合下腔静脉瘤栓取出术是新型、可行、但高危的手术方式。麻醉医师应当熟知具体手术操作步骤,以制定相关麻醉计划并密切配合,密切关注下腔静脉阻断期间循环波动,严防大出血、肺栓塞等严重并发症的发生。

Objective To investigate the safety and feasibility of anesthetic management in robot assisted laparoscopic radical nephrectomy with inferior venous caval thrombectomy.Methods From May 2013 to February 2016,25 patients with renal carcinoma and inferior vena cava thromerctomy were admitted to the hospital,21 were male,4 were female,and the range of age was 42- 81 years old.The hemodynamics,arterial blood gas test,waking hours after surgery and postoperative outcome were analyzed.Results Twenty-four cases completed the robot assisted laparoscopic radical nephrectomy.Compared with before the block,CVP and MAP decresed,the heart rate and SVV increased at block after 3min.One patient with trachea was admitted to the intensive care unit,the rest of the 23 patients were admitted to ordinary ward.No serious complications and deaths occured.Conclusion The robot assisted laparoscopic radical nephrectomy nephrectomy with inferior vena caval thrombectomy under the joint bolt is a new and feasible approach,but it is the surgical procedure that carries high risks.