血管活性肠肽瘤切除术围术期麻醉管理经验总结  

Experience of perioperative anesthesia management in resection of vasoactive intestinal peptidoma

作　　者：黄爱玲 朱辉 钟强 李志勤 侯立朝 邓斌 HUANG Ai-ling;ZHU Hui;ZHONG Qiang;LI Zhi-qin;HOU Li-chao;DENG Bin(Department of Anesthesiology,Xiang'an Hospital of Xiamen University,Xiamen,Fujian 361102,China;不详)

机构地区：[1]厦门大学附属翔安医院麻醉科,福建厦门361102 [2]西安交通大学第一附属医院麻醉科,陕西西安710061

出　　处：《中国临床研究》2022年第7期1004-1008,共5页Chinese Journal of Clinical Research

基　　金：厦门市医疗卫生科技计划项目(3502Z20194046);福建省海峡医药卫生交流协会重点科研项目(2020HYH10)。

摘　　要：目的探讨罕见血管活性肠肽瘤(VIPoma)患者手术治疗的围术期麻醉管理。方法回顾性总结2019年11月11日至24日厦门大学附属翔安医院收治,主诉持续腹泻6年,诊断为神经内分泌肿瘤,择期开腹行腹膜后肿瘤切除术+射频消融术1例患者的围术期麻醉管理经验。结果术中实施了全身麻醉复合咽喉部表面麻醉及双侧腹横肌平面阻滞。综合麻醉管理包括:术前进行奥曲肽治疗;完善补钾、纠酸、抑制血管活性肠肽(VIP)等术前准备;术中监测有创血压,动态监测血气分析;着重维持血流动力学稳定、水电解质平衡、保护重要脏器功能等。手术顺利完成,患者腹泻症状消失,电解质水平恢复正常且稳定,好转出院。结论VIPoma围术期麻醉管理较为复杂、风险较高,但抓住该肿瘤患者术前基础及术中易发生血液动力学波动等特点,做好麻醉预案,选择合适的麻醉方式,并精心综合管理,有利于保证手术成功。Objective To investigate the perioperative anesthesia management of rare vasoactive intestinal peptidoma(VIPoma).Methods The perioperative anesthesia management experience of a patient who was admitted to Xiang an Hospital on November 11 to 24,2019,complained of continuous diarrhea for 6 years,diagnosed neuroendocrine tumors,and underwent elective laparotomy with retroperitoneal tumor resection and radiofrequency ablation was retrospectively summarized.Results General anesthesia combined with pharyngeal surface anesthesia and bilateral transverse abdominal muscle plane block were performed during the operation.Comprehensive anesthesia management includes:preoperative octreotide treatment;improve preoperative preparations such as potassium supplement,acid correction and inhibition of vasoactive intestinal peptide(VIP);intraoperative monitoring of invasive blood pressure and dynamic monitoring of blood gas analysis;focus on maintaining hemodynamic stability,water and electrolyte balance and protecting important organ functions.The operation was successfully completed,the patient s diarrhea symptoms disappeared,the electrolyte level returned to normal and stable,improved and discharged from the hospital.Conclusion The perioperative anesthesia management of VIPoma is complex and risky,but grasping the preoperative basis of the tumor patient and the characteristics of hemodynamic fluctuation during operation,preparing a good anesthesia plan,selecting appropriate anesthesia methods and careful comprehensive management are conducive to ensure the success of the operation.

关 键 词：血管活性肠肽瘤 腹膜后肿瘤切除术 腹膜后肿瘤射频消融术 麻醉管理 

分 类 号：R736.7[医药卫生—肿瘤]