北京大学学报（医学版）2024，Vol.56Issue(4)：631-635,5.DOI:10.19723/j.issn.1671-167X.2024.04.014
经食管超声心动图在肾切除术联合Mayo Ⅲ～Ⅳ级静脉瘤栓取栓术不同手术方式中的临床作用
Clinical effects of transesophageal echocardiography in different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ vena tumor thrombectomy
摘要
Abstract
Objective:To analyze the clinical effects of intraoperative transesophageal echocardio-graphy(TEE)in different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ inferior vena cave(IVC)tumor thrombectomy.Methods:In the study,28 patients who did surgery of nephrectomy and Mayo Ⅲ-Ⅳ IVC thrombectomys in Peking University Third Hospital from 2022 January to 2024 February were included.Of the 28 patients,16 patients did robotic surgery,2 patients did laparoscopic surgery,and 10 patients did open surgery.All patients'clinical data were collected.Results:Intra-operative TEE was used in 9 robotic surgeries,of which 7 cases showed image changes compared with preoperative image results.Intraoperative TEE indicated that tumor thrombus entered the right atrium in 2 cases,showed that tumor thrombus grade rose from Mayo Ⅲ to Mayo Ⅳ in 2 cases,and indicated that tumor thrombus adhered to IC wall in 3 cases.All of these surgical plans were timely adjusted.Intra-operative TEE was used in 6 cases of open surgery,and 4 cases of them showed Mayo grade changes com-pared with preoperative image results.Intraoperative TEE indicated that tumor thrombus adhered to the IVC wall in 3 cases,and tumor thrombus adhered to the IVC wall with thrombus in one case.The surgi-cal plans were adjusted,and the tumor thrombus was left or segmentally removed.Laparoscopic surgery did not use intraoperative TEE.The effects of intraoperative TEE included:the combination of explora-tion and TEE monitoring was used in open surgery,and tumor thrombus removal process was fully moni-tored by intraoperative TEE in the robotic surgery.Intraoperative TEE real-time monitored circulatory sta-tus and cardiac function changes.Conclusion:In different surgical methods for nephrectomy com-bined with Mayo Ⅲ-Ⅳ tumor thrombectomy,intraoperative TEE can re-determine the tumor thrombus grade and degree of tumor thrombus adhered to IVC,track the tumor thrombus removal process in real-time,and monitor circulatory status and cardiac function changes.Intraoperative TEE plays an important role in different surgical methods,but its clinical application is still insufficient.Intraoperative TEE is recommended to such type of surgeries.关键词
经食道超声心动图/Mayo Ⅲ～Ⅳ级瘤栓/肾切除术/血栓切除术Key words
Transesophageal echocardiography/Mayo Ⅲ-Ⅵ tumor thrombus/Nephrectomy/Tumor thrombectomy分类
医药卫生引用本文复制引用
杨捷,冯杰莉,张树栋,马潞林,郑清..经食管超声心动图在肾切除术联合Mayo Ⅲ～Ⅳ级静脉瘤栓取栓术不同手术方式中的临床作用[J].北京大学学报（医学版）,2024,56(4):631-635,5.基金项目
海淀创新转化专项科创研发项目(2022Y78475-06)Supported by the Haidian Innovation and Transformation Special Science and Technology Innovation Research and Development Program(2022Y78475-06) （2022Y78475-06）
