Guo Xiangyang, Luo Ailun, Huang Yuguang, Ren Hongzhi, Ye Tiehu
Department of Anesthesia, Peking Union Medical College Hospital, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2002 Apr 25;82(8):523-6.
To investigate the clinical features of pheochromocytoma and summarize the experience of anesthetic management during perioperative period.
Two hundred and fifty eight medical records of patients who were diagnosed as pheochromocytoma in Peking Union Medical College Hospital were reviewed retrospectively for clinical features, anesthetic management and perioperative mortality.
About 5.8% (15/258) of pheochromocytomas was an integral part of multiple endocrine neoplasia (MEN) type II or mixed type. Sixty percent (149/249) of the patients undergoing surgery possessed evidence of catecholamine cardiac toxicity preoperatively, including abnormal ECG, myocardial hypertrophy and decreased left ventricular ejective fraction. Impaired glucose tolerance was found in 59% (147/249) of patients before surgery. The volume infused during operation was significantly higher both in the epidural anesthesia group (3 474 ml +/- 624 ml, q(1) = 5.72, P < 0.01) and in the epidural plus general anesthesia group (3 654 ml +/- 475 ml, q(2) = 5.83, P < 0.01) than that in the general anesthesia group (2 534 ml +/- 512 ml). There were favorable hemodynamic characteristics before removal of the tumor in the epidural anesthesia group and epidural plus general anesthesia group, as compared with in the general anesthesia group. Perioperative mortality was significantly decreased from 8% (5/60) in period 1 (from 1955 to 1975) to 1.2% (1/75) in period 2 (from 1976 to 1994) (chi(2) = 4.05, P < 0.01). No perioperative death (0/111) occurred in period 3 (from 1995 to 2001).
A good surgical outcome for the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential end organ damages and restoration of blood volume by establishing alpha-blockade during the preoperative period, meticulous anesthetic management during surgery, and appropriate circulatory support after surgery.
探讨嗜铬细胞瘤的临床特征，总结围手术期麻醉管理经验。
回顾性分析北京协和医院258例嗜铬细胞瘤患者的病历资料，分析其临床特征、麻醉管理及围手术期死亡率。
约5.8%（15/258）的嗜铬细胞瘤是多发性内分泌腺瘤病（MEN）Ⅱ型或混合型的一部分。60%（149/249）接受手术的患者术前有儿茶酚胺心脏毒性证据，包括心电图异常、心肌肥厚和左心室射血分数降低。59%（147/249）的患者术前存在糖耐量受损。硬膜外麻醉组（3474 ml±624 ml，q(1)=5.72，P<0.01）和硬膜外复合全身麻醉组（3654 ml±475 ml，q(2)=5.83，P<0.01）术中输液量均显著高于全身麻醉组（2534 ml±512 ml）。与全身麻醉组相比，硬膜外麻醉组和硬膜外复合全身麻醉组在肿瘤切除前血流动力学特征良好。围手术期死亡率从第1阶段（1955年至1975年）的8%（5/60）显著降至第2阶段（1976年至1994年）的1.2%（1/75）（χ(2)=4.05，P<0.01）。第3阶段（1995年至2001年）无围手术期死亡（0/111）。
嗜铬细胞瘤切除手术的良好预后取决于多种因素，包括术前仔细评估潜在的终末器官损害并通过建立α受体阻滞恢复血容量、术中精心的麻醉管理以及术后适当的循环支持。
