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手术技术对嗜铬细胞瘤患者血流动力学不稳定的影响：一项单中心回顾性队列研究。

Impact of surgical technique on hemodynamic instability in patients with pheochromocytoma: a single-centre retrospective cohort study.

作者信息

Chaman Baz Amir-Hossein, van de Wal Julie, Willems Simone A A, d'Ancona Frank, Zhu Xiaoye, Timmers Henri J L M, Langenhuijsen Johan F

机构信息

Department of Urology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.

Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

出版信息

Surg Endosc. 2025 May 15. doi: 10.1007/s00464-025-11794-2.

DOI:10.1007/s00464-025-11794-2

PMID:40374952

Abstract

BACKGROUND

Endoscopic adrenalectomy by either transperitoneal laparoscopic (TLA) or posterior retroperitoneoscopic approach (PRA) is the preferred treatment for pheochromocytoma (PCC). PRA shows advantages in patient outcome, but blood pressure fluctuations may occur due to limited working space and increased CO-pressure. We investigated the impact of surgical technique on intraoperative hemodynamic instability in patients with PCC.

METHODS

Patients who had endoscopic adrenalectomy for PCC consecutively from 2007 to 2022 were included in this retrospective cohort study. The primary outcome was hemodynamic instability (HI-score) and secondary outcomes were hemodynamic parameters and drug administration.

RESULTS

Overall, 101 patients met the inclusion criteria, 57 had TLA and 44 PRA. The two groups were similar in baseline characteristics. The HI-score was higher in PRA than in TLA (97 vs 46, p < 0.001) due to more frequent (IQR: 2-5 vs IQR: 1-3, p = 0.025) and longer episodes of hypotension (5.6% vs 7.1%, p = 0.013), and longer episodes of bradycardia (9.9% vs 16.9%, p = 0.038). On the contrary, TLA patients had higher maximum systolic blood pressure (169 mmHg vs 157 mmHg, p = 0.046), more frequent episodes of tachycardia (31.6% vs 6.8%, p = 0.002) and higher maximum heart rate (90 bpm vs 80 bpm, p = 0.024). PRA patients needed more vasoconstrictive drugs (97.7% vs 78.9%, p = 0.017) and fluid infusion (1111 ml/h vs 798 ml/h, p = 0.004), whereas TLA patients received more vasodilating drugs (64.9% vs 38.6%, p = 0.009).

CONCLUSIONS

PRA was associated with higher hemodynamic instability than TLA reflected by hypotension, need for vasoconstrictive drugs and fluid infusion in a selected cohort of patients with pheochromocytoma.

摘要

背景

经腹腹腔镜肾上腺切除术（TLA）或后腹腔镜肾上腺切除术（PRA）是嗜铬细胞瘤（PCC）的首选治疗方法。PRA在患者预后方面显示出优势，但由于工作空间有限和二氧化碳压力增加，可能会出现血压波动。我们研究了手术技术对PCC患者术中血流动力学不稳定的影响。

方法

本回顾性队列研究纳入了2007年至2022年连续接受内镜下肾上腺切除术治疗PCC的患者。主要结局是血流动力学不稳定（HI评分），次要结局是血流动力学参数和药物使用情况。

结果

总体而言，101例患者符合纳入标准，57例行TLA，44例行PRA。两组基线特征相似。由于低血压发作更频繁（四分位间距：2 - 5次与四分位间距：1 - 3次，p = 0.025）、发作时间更长（5.6% vs 7.1%，p = 0.013）以及心动过缓发作时间更长（9.9% vs 16.9%，p = 0.038），PRA组的HI评分高于TLA组（97 vs 46，p < 0.001）。相反，TLA患者的最高收缩压更高（169 mmHg vs 157 mmHg，p = 0.046），心动过速发作更频繁（31.6% vs 6.8%，p = 0.002），最高心率更高（90次/分钟 vs 80次/分钟，p = 0.024）。PRA患者需要更多的血管收缩药物（97.7% vs 78.9%，p = 0.017）和液体输注（1111 ml/h vs 798 ml/h，p = 0.004），而TLA患者接受更多的血管舒张药物（64.9% vs 38.6%，p = 0.009）。