Fujisaki Akira, Takayama Tatsuya, Suzuki Motofumi, Kubo Taro, Teratani Takumi, Kurokawa Shinsuke, Kameda Tomohiro, Komatsubara Maiko, Morita Tatsuo, Fujimura Tetsuya
Department of Urology, Jichi Medical University, Tochigi, Japan.
Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan.
Int J Urol. 2021 May;28(5):598-604. doi: 10.1111/iju.14517. Epub 2021 Feb 22.
To elucidate the mechanism of hypertensive crisis during energy device ablation of the adrenal gland.
Electrocoagulation on the adrenal glands of six pigs was carried out with the same energy device (VIO300D) using four methods: (i) monopolar coagulation; (ii) monopolar soft coagulation using IO-advanced ball-type electrodes; (iii) bipolar soft coagulation by pinching; and (iv) bipolar soft coagulation by non-pinching (surface contact) using Bipolar forceps Premium. After electrocoagulation for 5 s, blood pressure and pulse changes were monitored, and adrenal hormones were measured from a central vein. The adrenal glands were removed, and the degree of tissue damage was scored histologically.
Hypertensive crisis occurred with electrocoagulation of the adrenal gland by the monopolar coagulation, monopolar soft coagulation and bipolar soft coagulation pinching methods. Blood pressure did not change with the bipolar soft coagulation non-pinching method. Pathologically, tissue damage to the adrenal medulla was associated with elevated blood pressure and adrenaline and noradrenaline release.
Hypertensive crisis caused by energy device ablation to the adrenal gland is caused by the release of catecholamines due to heat damage to the adrenal medulla rather than the type of energy device. Proper use of an energy device that does not cause thermal degeneration of the medulla is required to prevent hypertensive crisis.
阐明肾上腺能量设备消融期间高血压危象的机制。
使用同一能量设备（VIO300D）对六头猪的肾上腺进行电凝，采用四种方法：（i）单极电凝；（ii）使用IO-advanced球型电极进行单极软凝；（iii）通过夹捏进行双极软凝；（iv）使用Bipolar forceps Premium通过非夹捏（表面接触）进行双极软凝。电凝5秒后，监测血压和脉搏变化，并从中心静脉测量肾上腺激素。切除肾上腺，对组织损伤程度进行组织学评分。
单极电凝、单极软凝和双极软凝夹捏法对肾上腺进行电凝时发生高血压危象。双极软凝非夹捏法时血压未发生变化。病理上，肾上腺髓质的组织损伤与血压升高以及肾上腺素和去甲肾上腺素释放有关。
能量设备消融肾上腺引起的高血压危象是由于肾上腺髓质热损伤导致儿茶酚胺释放所致，而非能量设备类型。为预防高血压危象，需要正确使用不会导致髓质热变性的能量设备。
