【摘要】：目的探討氣腹和腹腔鏡操作對(duì)腎上腺嗜鉻細(xì)胞瘤術(shù)中血流動(dòng)力學(xué)的影響。方法回顧性分析2004年4月~2013年5月手術(shù)治療嗜鉻細(xì)胞瘤101例的臨床資料,腹腔鏡組49例,開(kāi)放組52例,記錄2組在麻醉插管后、建立氣腹/手術(shù)開(kāi)始、游離腫瘤、腫瘤切除后、返回復(fù)蘇室5個(gè)時(shí)點(diǎn)動(dòng)脈收縮壓(SP)、舒張壓(DP)、心率(HR)的變化,比較術(shù)中心動(dòng)過(guò)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(shù)時(shí)間、術(shù)中出血量、術(shù)后住院時(shí)間。結(jié)果 2組5個(gè)時(shí)間點(diǎn)的SP、DP、HR以及術(shù)中血流動(dòng)力學(xué)不穩(wěn)定(發(fā)生高血壓危象、心動(dòng)過(guò)速或低血壓3種情況中的至少1種)的發(fā)生率,心動(dòng)過(guò)速、高血壓危象、低血壓發(fā)生率差異均無(wú)顯著性(P0.05)。腹腔鏡組手術(shù)時(shí)間短[(99.4±36.2)min vs.(154.5±75.0)min,t=-4.751,P=0.000],術(shù)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(shù)后住院時(shí)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(xì)胞瘤術(shù)中能得到良好的耐受,腹腔鏡手術(shù)與開(kāi)放手術(shù)相比并不增加特別的風(fēng)險(xiǎn)。因?yàn)槠鋼p傷小、恢復(fù)快,腹腔鏡可以作為嗜鉻細(xì)胞瘤手術(shù)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(xué)附屬東陽(yáng)醫(yī)院泌尿外科;浙江大學(xué)附屬第一醫(yī)院泌尿外科;
【分類(lèi)號(hào)】：R736.6

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