Subramaniam R, Pandit B, Sadhasivam S, Sridevi K B, Kaul H L
Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Anaesth Intensive Care. 2000 Feb;28(1):49-53. doi: 10.1177/0310057X0002800109.
Over a period of 15 months, 11 patients with phaeochromocytoma underwent retroperitoneoscopic excision of their tumours. Five patients had bilateral tumours. All patients underwent thorough preoperative evaluation and preparation with alpha- and beta-blockade. In the majority of the patients a hypertensive response was seen during generation of pneumoretroperitoneum. However, the period of tumour dissection and excision was devoid of large haemodynamic fluctuations. The average time taken was 3.5 to 4 hours per gland. Blood loss in successful laparoscopic excision averaged 240 ml (range 120 to 700 ml). In these patients satisfactory postoperative analgesia could be provided with intramuscular pethidine or intramuscular diclofenac sodium. In three patients the procedure had to be converted to open laparotomy due to haemorrhage. All three patients had preoperative radiological evidence of inferior vena cava and aortic involvement. Patient selection plays an important role in a successful outcome.
在15个月的时间里，11例嗜铬细胞瘤患者接受了后腹腔镜肿瘤切除术。5例患者为双侧肿瘤。所有患者均接受了全面的术前评估，并使用α和β受体阻滞剂进行了准备。大多数患者在建立后腹腔气腹时出现高血压反应。然而，肿瘤切除阶段没有出现大的血流动力学波动。每个腺体平均手术时间为3.5至4小时。成功的腹腔镜切除术中平均失血量为240毫升（范围为120至700毫升）。这些患者术后通过肌内注射哌替啶或肌内注射双氯芬酸钠可获得满意的镇痛效果。3例患者因出血不得不转为开放剖腹手术。所有3例患者术前影像学检查均有下腔静脉和主动脉受累的证据。患者选择对成功的手术结果起着重要作用。
