【摘要】：目的探討氣腹和腹腔鏡操作對腎上腺嗜鉻細胞瘤術中血流動力學的影響。方法回顧性分析2004年4月~2013年5月手術治療嗜鉻細胞瘤101例的臨床資料,腹腔鏡組49例,開放組52例,記錄2組在麻醉插管后、建立氣腹/手術開始、游離腫瘤、腫瘤切除后、返回復蘇室5個時點動脈收縮壓(SP)、舒張壓(DP)、心率(HR)的變化,比較術中心動過速(HR100次/min)、高血壓危象(血壓180/100 mm Hg)、低血壓(SP90 mm Hg)的發(fā)生率以及手術時間、術中出血量、術后住院時間。結(jié)果 2組5個時間點的SP、DP、HR以及術中血流動力學不穩(wěn)定(發(fā)生高血壓危象、心動過速或低血壓3種情況中的至少1種)的發(fā)生率,心動過速、高血壓危象、低血壓發(fā)生率差異均無顯著性(P0.05)。腹腔鏡組手術時間短[(99.4±36.2)min vs.(154.5±75.0)min,t=-4.751,P=0.000],術中出血少[中位數(shù)50(10~1300)ml vs.300(50~10 000)ml,Z=-6.529,P=0.000],術后住院時間短[(5.8±1.9)d vs.(10.8±4.6)d,t=-7.188,P=0.000]。結(jié)論CO2氣腹在腎上腺嗜鉻細胞瘤術中能得到良好的耐受,腹腔鏡手術與開放手術相比并不增加特別的風險。因為其損傷小、恢復快,腹腔鏡可以作為嗜鉻細胞瘤手術的首選。
[Abstract]:Objective to investigate the effect of pneumoperitoneum and laparoscopy on hemodynamics in adrenal pheochromocytoma. Methods the clinical data of 101 cases of pheochromocytoma treated by operation from April 2004 to May 2013 were retrospectively analyzed. 49 cases in the laparoscopic group and 52 cases in the open group. After anesthesia intubation, the pneumoperitoneum / operation was established, the tumor was free and the tumor was resected. Arterial systolic pressure (SP),) and diastolic blood pressure (DP),) (DP), heart rate (HR) changes at 5 time points in the resuscitation chamber were compared to compare intraoperative tachycardia (HR100 times / min), hypertensive crisis) (blood pressure 180 / 100 mm Hg),). Incidence of hypotension (SP90 mm Hg), duration of operation, intraoperative bleeding, postoperative hospital stay. Results the incidence of SP,DP,HR and intraoperative hemodynamic instability (at least one of the 3 cases of hypertension crisis, tachycardia or hypotension), tachycardia and hypertension crisis were observed at 5 time points in the two groups. There was no significant difference in the incidence of hypotension (P0.05). In the laparoscopy group, the operative time was short [(99.4 鹵36.2) min vs. (, 154.5 鹵75.0) min,t=-4.751,P=0.000], and the intraoperative bleeding was less [median 50 (10 1 300) ml vs.300 (50 10 000) ml,Z=-6.529,P=0.000]. The hospital stay was short after operation [(5.8 鹵1.9) d vs. (10.8 鹵4.6) days]. Conclusion CO2 pneumoperitoneum can be well tolerated during adrenal pheochromocytoma, and laparoscopic surgery does not increase the risk of adrenal pheochromocytoma. Because of its small damage and rapid recovery, laparoscopy can be the first choice for pheochromocytoma surgery.
【作者單位】： 溫州醫(yī)科大學附屬東陽醫(yī)院泌尿外科;浙江大學附屬第一醫(yī)院泌尿外科;
【分類號】：R736.6

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