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首页> 外文期刊>Journal of cardiac surgery. >Deep hypothermia and circulatory arrest in the surgical management of renal tumors with cavoatrial extension.
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Deep hypothermia and circulatory arrest in the surgical management of renal tumors with cavoatrial extension.

机译：深低温和循环停止在伴有心房扩张的肾肿瘤的外科治疗中。

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BACKGROUND: The inferior vena cava (IVC) is involved in almost 5% to 10% of renal tumors. Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus. MATERIAL: From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case. METHOD: Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease. RESULTS: There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence. CONCLUSIONS: The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation.
机译：背景：下腔静脉（IVC）参与近5％至10％的肾肿瘤。它们的腔内延伸至心腔的发生与肿瘤血栓形成的百分比为1％。这项研究的目的是提出“根治”治疗的原则，该原则应与切除肾脏以及腔内肿瘤血栓有关。材料：从2003年到2008年，我们治疗了6例涉及IVC和/或右心室的肾细胞癌患者。导致诊断的主要症状是血尿，呼吸困难或下肢浮肿。肿瘤的扩展为IV型3例，III型2例，II型1例。方法：体外循环结合短时间的低温循环骤停是方法。进行根治性肾切除术结合开腹术和房室切开术以“阻滞”消灭肿瘤血栓，并通过肿瘤进行手术清除。结果：没有手术死亡。除一名肥胖患者发生术后胰腺炎并在术后第44天因呼吸衰竭死亡外，平均术后病程为11天。在171个月的累积术后随访期间，患者保持无复发。结论：体外循环和深低温循环阻滞的使用提供了一种很好的方法，可以根治性切除包括IVC的肾癌，具有良好的发病率和长期生存率。泌尿科医师和心脏外科医生的合作对于这种类型的手术是必要的。

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