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患者,女,44岁。以右心房粘液瘤切除术后8个月复发再收入院。经彩色超声、MR、CT检查证实,右心房内及下腔静脉内有大块漂浮梭形肿物,远端基底达髂总静脉、病人术前有心悸、双下肢浮肿。虽经卧床休息、强心利尿治疗,症状无明显好转。肝肾功能正常。经心外科及麻醉体外人员共同研究,提示术中将可能有大量失血。患者在静吸复合麻醉下,有创动静脉压力监测下实行腔静脉肿瘤切除术。手术开始即行晶胶体液扩容。手术经腹显露腔静脉。上至肝门后,双肾静脉上方。下至髂内外静脉分叉处。分别腔静脉上下端套阻断带。切开腔静脉前全身肝素化,便于失血回收。在静脉切开取肿物时,由于肿物长条状,迫使间断松阻断带取肿物。加上髂静脉根蒂切除操作,致使大量血液丢失。手术中在ACT监测下,利用体外循环机
Patient, female, 44 years old. 8 months after right atrial myxoma recurrence recurrence rehospitalization. Color ultrasound, MR, and CT examinations confirmed that there were large floating spindle-shaped masses in the right atrium and in the inferior vena cava. The distal base reached the common iliac vein. The patient had palpitations and edema of both lower extremities before surgery. Although bed rest, cardiac diuretic treatment, no significant improvement in symptoms. Liver and kidney functions are normal. The heart surgery and anesthesia in vitro personnel jointly studied, suggesting that there may be a large amount of blood loss during surgery. Patients under intravenous inhalation under combined anesthesia, invasive vena cava resection under pressure monitoring. At the beginning of the operation, the gelled body fluid was expanded. Surgical transvaginal revealed the vena cava. Up to the hilar, above the double renal veins. Down to the bifurcation of the internal and external veins. The upper and lower ends of the vena cava were blocked with a blockage. The systemic heparinization was performed before the vena cava was ligated to facilitate blood loss recovery. When the tumor was taken with a venous incision, the tumor was forced to break with a bandage because of a long strip of tumor. In addition to the removal of the iliac veins, a large amount of blood was lost. Under the ACT monitoring during operation, use the extracorporeal circulation machine