腎癌の右心房内に進展した腫瘍塞栓例に高度低体温循環停止を併用した手術経験

Abstract

68歳女.高度低体温・循環停止を用いて右腎細胞癌の心房内腫瘍塞栓摘出術を安全に施行した.この自験例から, 摘出後の復温に伴って大きな切開創から大量の出血がみられ, 充分な輸血の準備と手術後の注意深い循環動態の是正が重要であることを理解した

A 68-year-old woman underwent surgical treatment for renal cell carcinoma associated with tumor thrombus extending into the right atrium. Although the tumor thrombus reached the level of the right atrium, there were no other apparent metastases. Combination therapy with interferon alfa plus tegafur/uracil (UFT) was attempted with the expectation of reducing the tumor thrombus, but there was no change. Successful management was achieved with right radical nephrectomy, right auriculotomy, and partial cavectomy using cardiopulmonary bypass under high-grade hypothermia. After removal of the tumor and thrombus, blood loss was 13, 900 ml during the patient's recovery. She had mild heart failure for about two weeks after the operation, but recovered. She was discharged on the 40th day after the operation. Proper preparation for blood transfusion is the key point of this operation.