University Department of Surgery, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK
Surgeon. 2010 Feb;8(1):9-14. doi: 10.1016/j.surge.2009.10.009.
Perioperative haemodynamic changes are well recognised sequelae of adrenalectomy for phaeochromocytomas. The aim of this study was to compare haemodynamic changes in patients undergoing laparoscopic adrenalectomy (LA) for phaeochromocytomas and other adrenal tumours.
Patients were identified from a prospective database (Jan 1999-Feb 2008). All patients were managed by a multi-disciplinary team. Haemodynamic variables were: pulse, blood pressure and the requirement of antihypertensive or vasopressor therapies in the perioperative period.
Over the nine-year period, 34 consecutive patients underwent laparoscopic phaeochromocytoma resection (one patient had delayed contralateral LA) and 104 consecutive patients underwent LA for other tumours (two patients had delayed contralateral LA). 5 out of 35 resections in the phaeochromocytoma group experienced severe hypertension (systolic blood pressure (SBP) >200 mm Hg) compared to two out of 106 resections in the non phaeochromocytoma group (p=0.010). No patient in either group had a transient or persistent (>10 min) SBP >220 mm Hg. Intraoperative antihypertensive use was significantly increased in the phaeochromocytoma group (p<0.005). There were no significant differences between groups for persistent hypotension (SBP <80 mm Hg), heart rate >120/min and recovery room haemodynamic parameters.
LA for phaeochromocytoma can be accomplished with low perioperative haemodynamic complications when compared to LA for other adrenal tumours.
围手术期血流动力学变化是嗜铬细胞瘤切除术的常见后遗症。本研究旨在比较腹腔镜肾上腺切除术（LA）治疗嗜铬细胞瘤和其他肾上腺肿瘤患者的血流动力学变化。
患者从前瞻性数据库（1999 年 1 月至 2008 年 2 月）中被识别出来。所有患者均由多学科团队管理。围手术期的血流动力学变量包括：脉搏、血压以及术中降压或升压治疗的需求。
在九年期间，35 例连续患者接受了腹腔镜嗜铬细胞瘤切除术（1 例患者延迟了对侧 LA），104 例连续患者接受了 LA 治疗其他肿瘤（2 例患者延迟了对侧 LA）。在嗜铬细胞瘤组中，有 5 例（5/35）出现严重高血压（收缩压（SBP）>200mmHg），而非嗜铬细胞瘤组中有 2 例（2/106）（p=0.010）。两组均无患者出现一过性或持续性（>10 分钟）SBP>220mmHg。嗜铬细胞瘤组术中降压药物的使用显著增加（p<0.005）。两组间持续性低血压（SBP<80mmHg）、心率>120/min 和恢复室血流动力学参数无显著差异。
与 LA 治疗其他肾上腺肿瘤相比，LA 治疗嗜铬细胞瘤可降低围手术期血流动力学并发症的发生率。
