循环旁路技术在肾癌合并下腔静脉癌栓外科治疗中的应用进展

Research advances of circulatory bypass technology in surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus

肾细胞癌(renal cell carcinoma,RCC)合并MayoⅢ~Ⅳ级下腔静脉癌栓的外科治疗难度极高,切除此类癌栓常需阻断肝门血管和下腔静脉。体外循环(cardiopulmonary bypass,CPB)和深低温停循环(deep hypothermic circulatory arrest,DHCA)等循环旁路技术能够建立新的循环通路以维持机体循环系统的正常运转,保护机体重要器官,从而保证手术的安全性。使用CPB和DHCA可能出现出血、神经系统功能障碍等并发症,其应用存在一定局限性。本文对以CPB和DHCA为代表的循环旁路技术在肾癌合并下腔静脉癌栓外科治疗中的应用进展进行综述,并讨论其并发症和应对策略。

The surgical treatment of renal cell carcinoma(RCC)with concurrent MayoⅢ-IV inferior vena cava tumor thrombus presents significant challenges due to the necessity for hepatic portal vasculature and inferior vena cava occlusion to facilitate tumor thrombus removal.Circulatory bypass techniques,such as cardiopulmonary bypass(CPB)and deep hypothermic circulatory arrest(DHCA),afford the establishment of alternative circulatory routes to maintain regular systemic circulation and protect vital organs,thereby ensuring surgical safety.Nevertheless,potential complications,including bleeding and neurological dysfunction,limit the application of CPB and DHCA.This article provides a review of the advancements in surgical treatment of renal carcinoma with inferior vena cava thrombus using bypass techniques epitomized by CPB and DHCA,and discusses their complications and corresponding management strategies.