Murat UĞURLUCAN, Didem Melis ÖZTAŞ, Selçuk ERDEM, Feza EKİZ, Zerrin SUNGUR, Başak ERGİNEL, Öner ŞANLI, Faruk ÖZCAN, Ali Haluk ANDER, İsmet NANE, Ufuk ALPAGUT

SAĞ ATRİUMA UZANIM GÖSTEREN RENAL TÜMÖRLERDE İNFRARENAL VENA KAVA İNFERİOR KANULASYONU – HİPOTERMİK DOLAŞIM DURDURULMASINI ENGELLEYEN YÖNTEM

Amaç: Vena kava trombektomisi ile birlikte yapılan radikal tümör eksizyonu, kavoatrial tümör trombozlarının tedavisinde son derece önemlidir. Bu yazıda sağ atriuma uzanım gösteren renal tümörlerde uyguladığımız hipotermik dolaşım durdurulmasını engelleyen infrarenal vena kava inferior kanülasyon tekniğini anlatmaktayız. Yöntemler: Haziran 2013-Aralık 2017 tarihleri arasında intrakardiak uzanım gösteren böbrek kaynaklı tümör saptanan 5 hasta tarafımıza konsülte edilmiştir. Hastaların yaş ortalaması 43,2 yıl idi. Pediatrik ve 1 yetişkin hasta erkek, diğer 3 yetişkin hasta kadındı. Operasyonlarda vena kava superior, infrarenal vena kava inferior ve two-stage venöz kanüller takılı olan üçlü venöz kanülasyon sistemi kullanıldı. Vena kava süperior ve infrarenal vena kava inferior kanülasyonlarını takiben tümör trombüsü çıkarıldı. Atriotomi kapatılırken two-stage venöz kanül sağ atriuma yerleştirildi. Prosedüre usulünce devam edildi. Bulgular: Operasyon sırasında ya da sonrasında mortalite gözlenmedi. Ortalama operasyon süresi 465 dk, kardiyopulmoner bypass süresi 48 dk ve myokardial iskemi süresi 27 dk idi. Hepatik ve renal iskemi süreleri ortalama 15,4 dk oldu. Ortalama yoğun bakım ve hastanede kalış süreleri sırasıyla 28,4 saat ve 9,3 gün hesaplandı.Toplam takip süresi 12 ay idi. Hiç bir hastada uzun dönem takiplerde mortalite ile karşılaşılmadı. Sonuç: Tümörün tamamen çıkarılması ve rezidü trombüs bırakılmaması bu hasta grubunun mortalitesini belirleyen en önemli etkenlerdendir. Uyguladığımız teknikle birlikte hastalarda hipotermik dolaşıma gereksinim duyulmadan orta hipotermide tam bir tümör eksizyonu sağlanmış ve trombüs dokusu bırakılmadığından emin olunmuştur.

Anahtar Kelimeler:

Vena kava inferior, Böbrek kanseri, Tümör trombüsü, kardiyopulmoner bypass

INFRARENAL INFERIOR VENA CAVA CANNULATION DURING THE RESECTION OF RENAL TUMORS EXTENDING INTO THE RIGHT HEART – NO NEED FOR HYPOTHERMIC TOTAL CIRCULATORY ARREST

Objective: Vena cava thrombectomy together with radical tumor excision in the case of cavoatrial tumor thrombosis is vitally important. In this document, we present the infrarenal inferior vena cava cannulation technique which overcomes the need of total circulatory arrest during the treatment of renal tumors extending into the right atrium. Methods: Between June 2013 and December 2017, 5 patients with renal tumors extending into the right atrium, were diagnosed. The mean age of the patients was 43.2 years. One pediatric and 1 adult patient were male, the other 3 were adult females. The three-venous cannulation system containing vena cava superior, infrarenal vena cava inferior and two-stage venous cannulae was used. The tumor thrombus was removed following vena cava superior and infrarenal vena cava inferior cannulations. A two-stage venous cannula was placed in the right atrium while closing atriotomy. The procedure was continued. Results: There was no mortality in the peroperative and postroperative period. The mean operation time was 465 minutes, the duration of cardiopulmonary bypass was 48 minutes and myocardial ischemia time was 27 minutes. The mean hepatic and renal ischemia time was 15.4 minutes. The mean intensive care unit and hospital stay were 28.4 hours and 9.3 days, respectively. The total follow-up period was 12 months. There was no mortality in long term follow-up. Conclusion: Complete tumor resection without any remnant is the main predictor of mortality in this particular patient population. This technique allows tumor resection in moderate hypothermia without needing hypothermic circulation and provides a safe procedure for complete resection.

Keywords:

Inferior vena cava, Kidney cancer, Tumor thrombus, Cardiopulmonary bypass,

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