Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Updates Surg. 2019 Sep;71(3):543-547. doi: 10.1007/s13304-018-00610-3. Epub 2018 Dec 1.
Synchronous posterior retroperitoneoscopic bilateral adrenalectomy (PR-BilA) is a novel technique proposed for the definitive cure of hypercortisolism when a surgical approach is indicated. The aim of the present prospective cohort study was to compare the carbon dioxide (CO) absorption in patients undergoing PR-BilA with those undergoing single posterior retroperitoneoscopic adrenalectomy (PRA). Twenty-nine patients undergoing PR-BilA or PRA were consecutively enrolled. Anaesthesia was standardised. In both groups, CO elimination (VCO), CO dissolved in arterial blood (PaCO), end-tidal CO (EtCO), and volume per minute (VM) were measured at the following time points: after anaesthesia induction and before CO insufflation (T1), 5 min after CO insufflation (T2), at the time of maximum VCO (T3), and at desufflation (T4). VCO was continuously measured using a metabolic monitor. ANOVA for repeated measures was used for statistical analysis. With respect to VCO, a significant group × time interaction was found (p = 0.03). Post hoc analysis revealed that VCO was significantly increased at T4 compared with T1 in both groups (p = 0.02 and p = 0.0001 in the PRA and PR-BilA groups, respectively). Regarding PaCO, ANOVA analysis showed a significant group effect (p = 0.01), with higher values in the PR-BilA group. EtCO and VM did not differ between the two groups. We found that the CO absorption was increased in both groups at the end of surgery, in the presence of a higher trend in PaCO values during PR-BilA. Therefore, PR-BilA may be considered a safe surgical approach with respect to CO absorption, when a mild degree of hypercapnia may be accepted.
同期双侧后腹腔镜肾上腺切除术（PR-BilA）是一种新颖的技术，当需要手术治疗时，可用于根治皮质醇增多症。本前瞻性队列研究的目的是比较接受 PR-BilA 和单侧后腹腔镜肾上腺切除术（PRA）的患者的二氧化碳（CO）吸收情况。连续纳入 29 例接受 PR-BilA 或 PRA 的患者。麻醉标准化。在两组中，均在以下时间点测量 CO 消除（VCO）、动脉血中溶解的 CO（PaCO）、呼气末 CO（EtCO）和每分钟体积（VM）：麻醉诱导后和 CO 充气前（T1）、CO 充气后 5 分钟（T2）、VCO 最大值时（T3）和放气时（T4）。使用代谢监测仪连续测量 VCO。采用重复测量方差分析进行统计学分析。就 VCO 而言，发现组间×时间交互作用具有统计学意义（p=0.03）。事后分析显示，两组在 T4 时的 VCO 均显著高于 T1（p=0.02 和 p=0.0001，分别在 PRA 和 PR-BilA 组）。关于 PaCO，方差分析显示组间存在显著差异（p=0.01），PR-BilA 组的 PaCO 值更高。EtCO 和 VM 两组间无差异。我们发现两组患者在手术结束时 CO 吸收增加，PR-BilA 期间 PaCO 值呈升高趋势。因此，在可以接受轻度高碳酸血症的情况下，PR-BilA 可被认为是一种安全的手术方法。
