Kinney M A, Warner M E, vanHeerden J A, Horlocker T T, Young W F, Schroeder D R, Maxson P M, Warner M A
Departments of Anesthesiology, Mayo Foundation, Rochester, Minnesota, USA.
Anesth Analg. 2000 Nov;91(5):1118-23. doi: 10.1097/00000539-200011000-00013.
Pheochromocytomas and paragangliomas are often surgically curable. However, resection of these tumors can be life threatening. We undertook this study to determine the frequency of, and risk factors for, perioperative complications in patients undergoing resection of pheochromocytoma or paraganglioma. We retrospectively reviewed the medical records of patients during 1983-1996 who underwent surgical resection of catecholamine-secreting pheochromocytoma or paraganglioma. Preoperative risk factors, adverse intraoperative events, and complications occurring in the 30 days after operation were recorded. Blood pressures were collected from manual records. The ranked sum test and Fisher's exact test were used for analyses. Adverse perioperative events or complications occurred in 45 of 143 patients (31.5%; exact 95% confidence interval, 24.0% to 39.8%). Of these 45 patients, 41 experienced one or more adverse intraoperative events. The most common adverse event was sustained hypertension (36 patients). There were no perioperative deaths, myocardial infarctions, or cerebrovascular events. Preoperative factors univariately associated with adverse perioperative events included larger tumor size (P: = 0.007), prolonged duration of anesthesia (P: = 0.015), and increased levels of preoperative urinary catecholamines and catecholamine metabolites: vanillylmandelic acid (P: = 0.019), metanephrines (P: = 0.004), norepinephrine (P: = 0. 014), and epinephrine (P: = 0.004). Despite premedication of most patients with phenoxybenzamine and a beta-adrenergic blocker, varying degrees of intraoperative hemodynamic lability occurred.
Few patients who had pheochromocytoma or paraganglioma resection experienced significant perioperative morbidity and none died in the largest retrospective study on this topic to date. This study confirms the very good perioperative outcomes demonstrated in smaller studies on this high-risk population, and identifies several risk factors for adverse outcomes.
嗜铬细胞瘤和副神经节瘤通常可通过手术治愈。然而，切除这些肿瘤可能危及生命。我们开展这项研究以确定接受嗜铬细胞瘤或副神经节瘤切除术患者围手术期并发症的发生率及危险因素。我们回顾性分析了1983年至1996年间接受分泌儿茶酚胺的嗜铬细胞瘤或副神经节瘤手术切除患者的病历。记录术前危险因素、术中不良事件及术后30天内发生的并发症。血压数据从手工记录中收集。采用秩和检验及Fisher精确检验进行分析。143例患者中有45例（31.5%；确切95%置信区间为24.0%至39.8%）发生围手术期不良事件或并发症。在这45例患者中，41例经历了一次或多次术中不良事件。最常见的不良事件是持续性高血压（36例）。未发生围手术期死亡、心肌梗死或脑血管事件。术前与围手术期不良事件单因素相关的因素包括肿瘤体积较大（P = 0.007）、麻醉时间延长（P = 0.015）以及术前尿儿茶酚胺和儿茶酚胺代谢产物水平升高：香草扁桃酸（P = 0.019）、甲氧基肾上腺素（P = 0.004）、去甲肾上腺素（P = 0.014）和肾上腺素（P = 0.004）。尽管大多数患者术前使用了苯氧苄胺和β肾上腺素能阻滞剂进行预处理，但术中仍出现了不同程度的血流动力学不稳定。
在迄今为止关于该主题的最大规模回顾性研究中，接受嗜铬细胞瘤或副神经节瘤切除术的患者很少发生严重围手术期并发症，且无死亡病例。本研究证实了在针对这一高风险人群的较小规模研究中所显示的良好围手术期结局，并确定了若干不良结局的危险因素。
