Objective:To investigate the safety and feasibility of anesthetic management in radical nephrectomy and Mayo 0-Ⅱ venous thrombectomy.Methods:The clinical data of 40 patients with Mayo 0-Ⅱ tumor thrombus from February 2015 to January 2017 were analyzed retrospectively.In the 40 patients,35 were male and 5 were female.The average age was(60.1±11.5) years old(25 to 84 years).The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 13 cases,typeⅠ thrombus in 10 cases,type Ⅱ thrombus in 17 cases(Mayo Medical Center classification).There were 4 cases of ASA I,32 cases of ASA II and 4 cases in ASA Ⅲ according to the American Society of Anesthesiologists.The anesthesia time,the total volume of crystalloid and colloid,intraoperative hemodynamic changes,and postoperative outcome were analyzed.Results:All the 40 surgeries were completed successfully without intraoperative and perioperative mortality.Open radical nephrectomy and inferior vena cava thrombectomy was underwent in 10 cases.Pure laparoscopic surgery was underwent in 30 cases.One case was converted to open surgery.The average operative time of 40 patients was(305.7±114.1) min,the average anesthesia time was(368.3±115.1) min.The intraoperative blood loss volume was(823.3±930.2)ml,the average intraoperative transfusion volume of red blood cell was(546.9±687.3) ml.27 cases of Mayo Ⅰ-Ⅱtumor thrombus had intraoperative inferior vena cava block,the block time was from 10 to 60 min,with an average of(24.2±12.4) min.Compared with before the block,the heart rate of 10 min after blocked increased significantly(P<0.05).End tidal carbon dioxide partial pressure(PETCO.2)of 5 min after blocked decreased significantly.PETCO.2 of 5 min and 10 min after block opening increased significantly(P<0.05).Other hemodynamics were stable(P>0.05).No serious complications such as pulmonary embolism and deaths occured.Conclusion:Clinical management on the anesthesia for radical nephrectomy and Mayo 0-Ⅱ venous thrombectomy is safe and feasible.The intraoperative hemodynamic changes are relatively stable during inferior vena cava block.%目的:探讨根治性肾切除术联合Mayo 0-Ⅱ级静脉癌栓取出术临床麻醉管理的安全性和可行性.方法:回顾性分析2015年2月至2017年1月北京大学第三医院泌尿外科单中心收治的40例肾癌合并Mayo 0-Ⅱ级静脉癌栓患者的临床资料.其中男性35例,女性5例.年龄25~84岁,平均(60.1±11.5)岁.本组40例肾癌患者中,合并Mayo 0级癌栓者13例,MayoⅠ级癌栓者10例,MayoⅡ级者17例.ASA I级者4例,Ⅱ级者32例,Ⅲ级者4例.分析40例患者麻醉时间、术中出入量、术中血流动力学变化、术后转归情况等.结果:本组40例Mayo 0-Ⅱ级肾癌伴静脉癌栓患者手术均顺利完成.行开放手术10例,行完全腹腔镜手术30例.1例患者先在后腹腔途径腹腔镜下行右肾根治性切除术,后中转开放取栓手术.40例患者手术平均时间(305.7±114.1) min,麻醉平均时间(368.3±115.1) min.术中出血量为(823.3±930.2) ml,术中输注悬浮红细胞平均(546.9±687.3) ml.27例MayoⅠ-Ⅱ级癌栓(下腔静脉癌栓)患者行术中下腔静脉阻断,下腔静脉阻断时间为10~60 min,平均(24.2±12.4) min.与阻断前即刻比较,下腔静脉阻断后10 min心率显著增快(P<0.05).下腔静脉阻断后5 min呼气末二氧化碳分压(end tidal carbon dioxide partial pressure,PETCO2 )较阻断前显著降低,阻断开放后5 min、10 min,PETCO2较阻断前显著升高(P<0.05).其他血流动力学指标稳定,较阻断前指标变化无统计学差异(P>0.05).所有病例术中、术后无肺栓塞等严重并发症发生,无疾病进展及死亡病例.结论:根治性肾切除术联合Mayo 0-Ⅱ级静脉癌栓取出术麻醉管理安全可行,手术中行下腔静脉阻断和开放期间循环相对稳定.
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