腹腔镜与开放手术在肾上腺嗜铬细胞瘤切除术中血流动力学变化的对比研究  

Comparative Study of Hemodynamic Parameters Between Laparoscopic and Open Adrenalectomy for Adrenal Pheochromocytoma

作　　者：金亿里[1] 汪朔[2] 周长春[1] 卢大乔[1] 熊冰[1] 傅军红[1] 

机构地区：[1]温州医科大学附属东阳医院泌尿外科,东阳322100 [2]浙江大学附属第一医院泌尿外科,杭州31000

出　　处：《中国微创外科杂志》2015年第5期440-443,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨气腹和腹腔镜操作对肾上腺嗜铬细胞瘤术中血流动力学的影响。方法回顾性分析2004年4月~2013年5月手术治疗嗜铬细胞瘤101例的临床资料,腹腔镜组49例,开放组52例,记录2组在麻醉插管后、建立气腹/手术开始、游离肿瘤、肿瘤切除后、返回复苏室5个时点动脉收缩压（SP）、舒张压（DP）、心率（HR）的变化,比较术中心动过速（HR〉100次/min）、高血压危象（血压〉180/100 mm Hg）、低血压（SP〈90 mm Hg）的发生率以及手术时间、术中出血量、术后住院时间。结果 2组5个时间点的SP、DP、HR以及术中血流动力学不稳定（发生高血压危象、心动过速或低血压3种情况中的至少1种）的发生率,心动过速、高血压危象、低血压发生率差异均无显著性（P〉0.05）。腹腔镜组手术时间短[（99.4±36.2）min vs.（154.5±75.0）min,t=-4.751,P=0.000],术中出血少[中位数50（10~1300）ml vs.300（50~10 000）ml,Z=-6.529,P=0.000],术后住院时间短[（5.8±1.9）d vs.（10.8±4.6）d,t=-7.188,P=0.000]。结论CO2气腹在肾上腺嗜铬细胞瘤术中能得到良好的耐受,腹腔镜手术与开放手术相比并不增加特别的风险。因为其损伤小、恢复快,腹腔镜可以作为嗜铬细胞瘤手术的首选。Objective To study the effects of carbon dioxide pneumoperitoneum and tumor manipulation on the intraoperative hemodynamic parameters in laparoscopy for adrenal pheochromocytoma . Methods We retrospectively analyzed data of 101 patients with pheochromocytoma from April 2004 to May 2013.The group A （ n =49 ） received laparoscopic and the group B （ n =52 ） underwent open surgery .The changes of artery systolic pressure （ SP） , diastolic pressure （ DP） , and heart rate （ HR） in two groups at time points of intubation , pneumoperitoneum establishment/beginning of surgery , mobilizing tumor , after tumor resection , and returning to the recovery room were recorded .The incidence of intraoperative hemodynamic instability （ defined as an intraoperative hypertensive crisis , tachycardia , or hypotension in at least one of three conditions ） , incidence of tachycardia （ HR 〉100 bpm ） , incidence of hypertensive crisis （ SP 〉180 mm Hg）, incidence of hypotension （ SP 〈90 mm Hg）, operative time, blood loss, postoperative hospital stay were compared between the two groups . Results The differences of SP , DP, HR in the group A at five time points were not statistically significant as compared with the group B （P〉0.05）.The incidences of intraoperative hemodynamic instability, tachycardia, hypertensive crisis, and hypotension were not significantly different between the two groups （P〉0.05）.The group A had shorter operative time [（99.4 ±36.2） min vs.（154.5 ±75.0） min, t=-4.751, P=0.000], less intraoperative blood loss [50 （10-1300） ml vs.300 （50-10 000） ml, Z=-6.529, P=0.000], shorter hospital stay [（5.8 ±1.9） d vs. （10.8 ±4.6） d, t=-7.188, P=0.000] as compared with the group B . Conclusions Carbon dioxide pneumoperitoneum is well tolerated in patients with pheochromocytoma . Laparoscopic adrenalectomy for pheochromocytoma does not increase the risks as compared with open surgery . Having advatages of minimal invasion and quick recovery , laparosco

关 键 词：嗜铬细胞瘤 腹腔镜 血流动力学 肾上腺切除术 

分 类 号：R736.6[医药卫生—肿瘤]