Pisarska-Adamczyk Magdalena, Zawadzka Karolina, Więckowski Krzysztof, Przęczek Krzysztof, Major Piotr, Wysocki Michał, Małczak Piotr, Pędziwiatr Michał
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
Gland Surg. 2021 Mar;10(3):892-900. doi: 10.21037/gs-20-783.
Adrenalectomy for pheochromocytoma, a rare catecholamine-secreting tumour, is a challenging procedure because of the high risk of intraoperative hemodynamic instability, which can cause life-threatening complications. Our study aimed to identify predictive factors for hemodynamic instability during pheochromocytoma resection as well as to assess the risk factors for postoperative morbidity.
Data of 96 patients, who underwent laparoscopic adrenalectomy were analysed retrospectively. Hemodynamic instability was defined as an occurrence of both intraoperative episodes of systolic blood pressure above 160 mmHg and vasoactive (vasodilators or vasoconstrictors) drug administration. Patients were divided into two groups: one which met both criteria, and another one without hemodynamic instability-42 (43.8%) and 54 (56.2%) respectively.
The mean tumour size was 4.5±2.0 cm. 86 patients had a sporadic pheochromocytoma and 10 (10.4%) had a familial disease. Sixty-three patients were preoperatively treated with nonselective blockers and 33 patients with selective blockers. Mean operative time was 98.7±41.7 min. and mean intraoperative blood loss was 165.7±381.2 mL. In 26% of patients, postoperative complications occurred. The median length of hospital stay was 3 days. The multivariate logistic regression model showed that the size of adrenal tumour and diabetes were significant factors of hemodynamic instability. Intraoperative use of vasopressors was an independent risk factor for both all-cause and cardiovascular morbidity.
Adrenal tumour size and diabetes were associated with hemodynamic instability during pheochromocytoma resection. The only risk factor for complications in our group was intraoperative necessity to use vasopressors.
嗜铬细胞瘤是一种罕见的分泌儿茶酚胺的肿瘤，因术中血流动力学不稳定风险高，肾上腺切除术是一项具有挑战性的手术，这种不稳定可导致危及生命的并发症。我们的研究旨在确定嗜铬细胞瘤切除术中血流动力学不稳定的预测因素，并评估术后发病的危险因素。
回顾性分析96例行腹腔镜肾上腺切除术患者的数据。血流动力学不稳定定义为术中出现收缩压高于160 mmHg且使用血管活性药物（血管扩张剂或血管收缩剂）。患者分为两组：一组符合两项标准，另一组无血流动力学不稳定，分别为42例（43.8%）和54例（56.2%）。
肿瘤平均大小为4.5±2.0 cm。86例患者患有散发性嗜铬细胞瘤，10例（10.4%）患有家族性疾病。63例患者术前接受非选择性阻滞剂治疗，33例患者接受选择性阻滞剂治疗。平均手术时间为98.7±41.7分钟，平均术中失血量为165.7±381.2 mL。26%的患者出现术后并发症。中位住院时间为3天。多因素logistic回归模型显示，肾上腺肿瘤大小和糖尿病是血流动力学不稳定的重要因素。术中使用血管升压药是全因发病和心血管发病的独立危险因素。
肾上腺肿瘤大小和糖尿病与嗜铬细胞瘤切除术中血流动力学不稳定有关。我们组并发症的唯一危险因素是术中需要使用血管升压药。
