儿童肾母细胞瘤合并Ⅳ级下腔静脉瘤栓体外循环围手术期管理1例

Perioperative management of Wilms tumor with inferior vena cava tumor thrombus in child:a case report

小儿肾脏恶性肿瘤合并下腔静脉瘤栓发生率仅为4%~10%,膈肌以上瘤栓(Mayo ClinicⅣ级)可能长入右心房内,需要小儿外科、泌尿外科和心脏外科联合手术,手术较复杂,并发症较多。文章报道1例4岁患儿术中采用静‑吸复合全身麻醉,麻醉诱导后先行肾动脉栓塞肿瘤主要供血血管,减少术中出血,切除肾肿瘤后,在体外循环下行瘤栓取出术。术中行经食管超声心动图实时监测,观察瘤栓位置变化。术后给予神经阻滞联合患者自控静脉镇痛(PCIA)多模式镇痛,患儿恢复良好。文章讨论了小儿体外循环管理、术后疼痛管理策略,以便为后续临床工作提供参考。

The occurrence rate of pediatric malignant renal tumors with inferior vena cava thrombus is only 4%‒10%.Tumors extending above the diaphragm(Mayo Clinic levelⅣ)have the potential to invade the right atrium.Removing the tumor needs a com‑plex surgical cooperative procedure from pediatric,urology,and cardiac surgery doctors,which may cause multiple complications.In this case,a 4‑year‑old patient underwent an intravenous‑inhalation combined anesthesia during surgery.After anesthesia induction,re‑nal artery embolization was performed on the main blood supply vessels of the tumor to reduce intraoperative bleeding.Following the re‑section of the renal tumor,tumor embolectomy was carried out with the assistance of cardiopulmonary bypass.Intraoperative transesoph‑ageal echocardiography was performed to observe the location of the tumor thrombus.Postoperatively,a combination of neural blockade and patient‑controlled intravenous analgesia(PCIA)was administered for pain management.The patient recovered well after surgery.This article discusses the strategies for perioperative management of pediatric patients undergoing cardiopulmonary bypass and postop‑erative pain management,providing valuable insights for future clinical practice.