Abstract:

This research provides an overview of the perioperative nursing care for a patient with a massive renal cell carcinoma and Mayo Stage Ⅲ tumor thrombus who underwent a robot-assisted nephrectomy complicated by significant intraoperative bleeding and CO₂ embolism. Key nursing considerations included multidisciplinary preoperative discussions，developing stepwise intraoperative emergency plans，establishing an integrated nursing workstation，and the optimization of patient monitoring. During the surgery，nursing efforts were focused on supporting the robot-assisted procedure，closely monitoring the patient’s condition，preventing intraoperative complications，initiating emergency plans as needed，actively managing major bleeding and CO₂ embolism，and implementing structured positioning to minimize the risk of falls during the procedure. Postoperatively，the focus was on preventing secondary thrombus formation，managing active bleeding，and monitoring for liver and kidney ischemia-reperfusion injury. Through multidisciplinary interventions and meticulous nursing care，the patient was discharged after a 13-day postoperative recovery.

Key words: Robotic Surgery, Renal Cell Carcinoma, Inferior Vena Cava Tumor Thrombus, Perioperative Nursing

摘要：

总结1例机器人辅助下切除巨大肾细胞癌伴MayoⅢ级癌栓患者术中大出血合并CO₂气体栓塞的围手术期护理经验，护理要点如下。术前参与多学科讨论，制订阶梯式术中应急预案；建立一体化护理工作站，优化病情监测。术中加强机器人辅助手术的护理配合；密切监测患者病情，预防术中危重并发症；启动应急预案，积极处理大出血合并CO₂气体栓塞；实施结构化体位管理，预防术中坠床风险。术后预防继发性血栓形成及活动性出血；加强肝肾缺血-再灌注损伤的监测与护理。经过多学科救治及精心护理，患者于术后13 d顺利出院。

关键词: 机器人手术, 肾细胞癌, 下腔静脉癌栓, 围手术期护理