Gaujoux Sébastien, Bonnet Stéphane, Lentschener Claude, Thillois Jean-Marc, Duboc Denis, Bertherat Jérôme, Samama Charles Marc, Dousset Bertrand
Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Descartes, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France.
Surg Endosc. 2016 Jul;30(7):2984-93. doi: 10.1007/s00464-015-4587-x. Epub 2015 Dec 18.
Adrenalectomy for pheochromocytoma is considered to be a challenging procedure because of the risk of hemodynamic instability (HI), which is poorly defined and unpredictable. The objective of this retrospective study from a prospectively maintained database was to determine the predictive factors for perioperative HI, which is defined as a morbidity-related variable, in patients undergoing unilateral laparoscopic adrenalectomy (LA) for pheochromocytoma.
A total of 149 patients with unilateral pheochromocytoma undergoing LA were included. First, HI was defined using independent hemodynamic variables associated with perioperative morbidity. Next, a multivariable logistic regression analysis was performed to determine the independent preoperative risk factors for HI.
There was no postoperative mortality, and the overall morbidity rate was 10.7 %. The use of a cumulative dose of norepinephrine >5 mg was the only independent hemodynamic predictive factor for postoperative complications; thus, this variable was used to define HI. A multivariate analysis revealed that a symptomatic high preoperative blood pressure (p = 0.003) and a ten-fold increase in urinary metanephrine and/or normetanephrine levels (p < 0.0001) were significant predictors of HI. When no predictive factors were present, the risk of HI and the postoperative morbidity were 1.5 and 4.3 %, respectively. However, when two predictive factors were present, the HI risk and the postoperative morbidity were 53.8 and 30.8 %, respectively.
Perioperative HI, defined as the need for a cumulative dose of norepinephrine >5 mg, is significantly associated with postoperative morbidity and can be predicted by symptomatic preoperative high blood pressure and above a ten-fold increase in urinary metanephrine and/or normetanephrine levels.
由于存在血流动力学不稳定（HI）风险，嗜铬细胞瘤的肾上腺切除术被认为是一项具有挑战性的手术，而这种风险定义不明确且不可预测。这项来自前瞻性维护数据库的回顾性研究的目的是确定接受单侧腹腔镜肾上腺切除术（LA）治疗嗜铬细胞瘤患者围手术期HI的预测因素，HI被定义为与发病率相关的变量。
共纳入149例接受LA治疗的单侧嗜铬细胞瘤患者。首先，使用与围手术期发病率相关的独立血流动力学变量来定义HI。接下来，进行多变量逻辑回归分析以确定HI的独立术前危险因素。
无术后死亡病例，总体发病率为10.7%。去甲肾上腺素累积剂量>5mg是术后并发症的唯一独立血流动力学预测因素；因此，该变量被用于定义HI。多变量分析显示，术前有症状的高血压（p = 0.003）以及尿间甲肾上腺素和/或去甲间肾上腺素水平升高10倍（p < 0.0001）是HI的显著预测因素。当不存在预测因素时，HI风险和术后发病率分别为1.5%和4.3%。然而，当存在两个预测因素时，HI风险和术后发病率分别为53.8%和30.8%。
围手术期HI定义为去甲肾上腺素累积剂量>5mg的需求，与术后发病率显著相关，可通过术前有症状的高血压以及尿间甲肾上腺素和/或去甲间肾上腺素水平升高10倍以上来预测。
