Usefulness of Cardiopulmonary Bypass in Cancer Surgery --- an Analysis of 12 Cases<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> 承耀中 孙 莉 中国协和医科大学肿瘤医院麻醉科,北京 100021 Yao-zhong Cheng, Li Sun Department of Anesthesiology,Cancer Institute & Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021 ABSTRACT Objective: To discuss the feasibility, method of anesthesia and complication in cancer surgery with cardiopulmonary bypass. Methods: A retrospective medical review was performed in 12 consecutive patients with advanced lung carcinoma, esophagus carcinoma or mediastinal tumor who underwent resection with cardiopulmonary bypass at Cancer Hospital of CAMS from June 1999 through March 2003. Results: The method of anesthesia was general anesthesia combined intravenous and inhaled anesthetics. During the cardiopulmonary bypass, we used only intravenous anesthetics. Currently, fentanyl is the most commonly used opioid; used alone in very large doses. In our series, we had little trouble with haemostasis during surgery. During the cardiopulmonary bypass, the hemodynamics was stable in ten patients. Of these 10 patients, eight recovered very well postoperatively; two developed cardiac and pulmonary failure, died within four days after operation. One patient died from heart failure after the cardiopulmonary bypass. One patient developed disturbance of consciousness after operation, and computed tomography of the brain showed infarction of the cerebrum. Conclusions: Now, surgical resection is the most important method in the cancer integrated treatment, even if in the advanced tumor treatment. Complete tumor excision with cardiopulmonary bypass, is a safe method to cure the advanced tumor. It is able to improve the patients' survival quality apparently, and maybe can prolong the life span. Key words: Cardiopulmonary bypass; anesthesia; tumor excision; surgery 临床工作中,我们有时会遇到晚期肿瘤侵犯周围重要脏器,例如晚期肺癌或纵隔肿瘤侵犯上下腔静脉、心包、心脏以及其它重要血管[1~4],晚期肾癌及其瘤栓侵犯下腔静脉甚至直达心房[14-17],晚期肝癌侵犯肝静脉、下腔静脉甚至直达心房[5~7],等等。如果这些患者能够得到及时的治疗,实施手术完整切除肿瘤,愈后还是比较乐观的[8],但是,实施此种手术必定要冒很大风险。如何在保证患者生命体征安全的前提下又能突破以往的手术禁区完整地切除肿瘤及其瘤栓?我们面临着很大的难题。而近年来有人使用体外循环转流切除晚期肿瘤则为这一难题提供了切实可行的解决方法。为了探讨体外循环转流在肿瘤患者手术中应用的可行性、麻醉方法以及可能出现的并发症,本项研究回顾分析了自1999年6月至2003年3月中国医学科学院肿瘤医院12例体外循环转流下实施晚期肺癌、食管癌以及纵隔肿瘤切除患者资料,现报告如下。 |