[Clinical effects of transesophageal echocardiography in different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ vena tumor thrombectomy].

Q3 Medicine

北京大学学报（医学版） Pub Date : 2024-12-18

Jie Yang, Jieli Feng, Shudong Zhang, Lulin Ma, Qing Zheng

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引用次数: 0

Abstract

Objective: To analyze the clinical effects of intraoperative transesophageal echocardiography (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 IVC 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 compared 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 surgical 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 exploration and TEE monitoring was used in open surgery, and tumor thrombus removal process was fully monitored by intraoperative TEE in the robotic surgery. Intraoperative TEE real-time monitored circulatory status and cardiac function changes.

Conclusion: In different surgical methods for nephrectomy combined 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.

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[经食道超声心动图在肾切除术联合梅奥Ⅲ-Ⅳ静脉肿瘤血栓切除术的不同手术方法中的临床效果]。

目的分析术中经食道超声心动图（TEE）在肾切除联合梅奥Ⅲ-Ⅳ型下腔静脉（IVC）肿瘤血栓切除术中不同手术方式的临床效果：方法：选取2022年1月至2024年2月在北京大学第三医院行肾切除联合梅奥Ⅲ-Ⅳ型下腔静脉肿瘤血栓切除术的28例患者作为研究对象。在28例患者中，16例患者接受了机器人手术，2例患者接受了腹腔镜手术，10例患者接受了开腹手术。收集了所有患者的临床数据：结果：9 例机器人手术中使用了术中 TEE，其中 7 例与术前图像结果相比发生了变化。术中 TEE 显示 2 例肿瘤血栓进入右心房，2 例肿瘤血栓等级由 Mayo Ⅲ级升至 Mayo Ⅳ级，3 例肿瘤血栓与 IVC 壁粘连。所有这些手术方案都得到了及时调整。6 例开放手术采用术中 TEE，其中 4 例与术前图像结果相比出现 Mayo 分级变化。术中 TEE 显示 3 例肿瘤血栓与 IVC 壁粘连，1 例肿瘤血栓与 IVC 壁血栓粘连。手术方案经调整后，肿瘤血栓被保留或分段切除。腹腔镜手术未使用术中 TEE。术中 TEE 的效果包括：开腹手术采用探查和 TEE 监测相结合的方式，机器人手术通过术中 TEE 全面监测肿瘤血栓清除过程。术中 TEE 实时监测循环状态和心功能变化：结论：在肾切除术联合梅奥Ⅲ-Ⅳ期肿瘤血栓切除术的不同手术方式中，术中 TEE 可以重新确定肿瘤血栓的分级和肿瘤血栓与 IVC 的粘连程度，实时跟踪肿瘤血栓清除过程，监测循环状态和心功能变化。术中 TEE 在不同的手术方法中发挥着重要作用，但其临床应用仍然不足。建议此类手术采用术中 TEE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

北京大学学报（医学版） Medicine-Medicine (all)

CiteScore

0.80

自引率

0.00%

发文量

9815

期刊介绍： Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.