嗜铬细胞瘤的临床特征及围手术期麻醉管理

Clinical features of pheochromocytoma and perioperative anesthetic management.

作者信息

Luo Ailun, Guo Xiangyang, Yi Jie, Ren Hongzhi, Huang Yuguang, Ye Tiehu

机构信息

Department of Anesthesia, Peking Union Medical College Hospital, Beijing 100730, China.

出版信息

Chin Med J (Engl). 2003 Oct;116(10):1527-31.

PMID:14570616

Abstract

OBJECTIVE

To investigate clinical features of pheochromocytoma and summarize experiences of anesthetic management during the perioperative period.

METHODS

Two hundred and fifty eight patients who were diagnosed with pheochromocytoma in our hospital were reviewed retrospectively for clinical features. According to different preoperative pharmalogical preparations, perioperative mortalities were analyzed in three periods (Period 1: January 1955 - December 1975; Period 2: January 1976 - December 1994; Period 3: January 1995 - July 2001). In Period 3, hemodynamic changes in the patients undergoing different anesthetic methods were analyzed.

RESULTS

About 5.8% (15/258) of pheochromocytoma was an integral part of multiple endocrine neoplasia (MEN) type II or mixed type. Sixty percent (149/249) of the patients who had undergone surgery possessed evidence of catecholamine cardiac toxicity preoperatively. Impaired glucose tolerance was found in 59% (147/249) of the patients before surgery. Perioperative mortality was significantly decreased from 8% (5/60) in Period 1 to 1.2% (1/75) in Period 2 (P < 0.01). No perioperative deaths occurred in Period 3. The volume infused during the operation was significantly higher both in the epidural anesthesia group (3474 ml +/- 624 ml, P < 0.01) and in the epidural plus general anesthesia group (3654 ml +/- 475 ml, P < 0.01) than in the general anesthesia group (2534 ml +/- 512 ml). There were favorable hemodynamic characteristics in patients before removal of the tumor in the epidural anesthesia group and in the epidural plus general anesthesia group, as compared with the general anesthesia group.

CONCLUSIONS

A positive surgical outcome of the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential vital organ damage before surgery and restoration of blood volume by establishing alpha-blockade preoperatively, meticulous anesthetic management of patients during surgery, and appropriate circulatory support after surgery.

摘要

目的

探讨嗜铬细胞瘤的临床特征，总结围手术期麻醉管理经验。

方法

回顾性分析我院确诊的258例嗜铬细胞瘤患者的临床特征。根据术前不同的药物准备情况，分析三个时期（时期1：1955年1月至1975年12月；时期2：1976年1月至1994年12月；时期3：1995年1月至2001年7月）的围手术期死亡率。在时期3，分析不同麻醉方法患者的血流动力学变化。

结果

约5.8%（15/258）的嗜铬细胞瘤是多内分泌腺瘤病（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。59%（147/249）的患者术前发现糖耐量受损。围手术期死亡率从时期1的8%（5/60）显著降至时期2的1.2%（1/75）（P<0.01）。时期3无围手术期死亡病例。硬膜外麻醉组（3474 ml±624 ml，P<0.01）和硬膜外复合全身麻醉组（3654 ml±475 ml，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患者在肿瘤切除前血流动力学特征良好。