腹腔镜与开放手术在肾上腺嗜铬细胞瘤切除术中血流动力学变化的对比研究
发布时间：2018-12-13 02:15
【摘要】：目的探讨气腹和腹腔镜操作对肾上腺嗜铬细胞瘤术中血流动力学的影响。方法回顾性分析2004年4月~2013年5月手术治疗嗜铬细胞瘤101例的临床资料,腹腔镜组49例,开放组52例,记录2组在麻醉插管后、建立气腹/手术开始、游离肿瘤、肿瘤切除后、返回复苏室5个时点动脉收缩压(SP)、舒张压(DP)、心率(HR)的变化,比较术中心动过速(HR100次/min)、高血压危象(血压180/100 mm Hg)、低血压(SP90 mm Hg)的发生率以及手术时间、术中出血量、术后住院时间。结果 2组5个时间点的SP、DP、HR以及术中血流动力学不稳定(发生高血压危象、心动过速或低血压3种情况中的至少1种)的发生率,心动过速、高血压危象、低血压发生率差异均无显著性(P0.05)。腹腔镜组手术时间短[(99.4±36.2)min vs.(154.5±75.0)min,t=-4.751,P=0.000],术中出血少[中位数50(10~1300)ml vs.300(50~10 000)ml,Z=-6.529,P=0.000],术后住院时间短[(5.8±1.9)d vs.(10.8±4.6)d,t=-7.188,P=0.000]。结论CO2气腹在肾上腺嗜铬细胞瘤术中能得到良好的耐受,腹腔镜手术与开放手术相比并不增加特别的风险。因为其损伤小、恢复快,腹腔镜可以作为嗜铬细胞瘤手术的首选。
[Abstract]:Objective to investigate the effect of pneumoperitoneum and laparoscopy on hemodynamics in adrenal pheochromocytoma. Methods the clinical data of 101 cases of pheochromocytoma treated by operation from April 2004 to May 2013 were retrospectively analyzed. 49 cases in the laparoscopic group and 52 cases in the open group. After anesthesia intubation, the pneumoperitoneum / operation was established, the tumor was free and the tumor was resected. Arterial systolic pressure (SP),) and diastolic blood pressure (DP),) (DP), heart rate (HR) changes at 5 time points in the resuscitation chamber were compared to compare intraoperative tachycardia (HR100 times / min), hypertensive crisis) (blood pressure 180 / 100 mm Hg),). Incidence of hypotension (SP90 mm Hg), duration of operation, intraoperative bleeding, postoperative hospital stay. Results the incidence of SP,DP,HR and intraoperative hemodynamic instability (at least one of the 3 cases of hypertension crisis, tachycardia or hypotension), tachycardia and hypertension crisis were observed at 5 time points in the two groups. There was no significant difference in the incidence of hypotension (P0.05). In the laparoscopy group, the operative time was short [(99.4 卤36.2) min vs. (, 154.5 卤75.0) min,t=-4.751,P=0.000], and the intraoperative bleeding was less [median 50 (10 1 300) ml vs.300 (50 10 000) ml,Z=-6.529,P=0.000]. The hospital stay was short after operation [(5.8 卤1.9) d vs. (10.8 卤4.6) days]. Conclusion CO2 pneumoperitoneum can be well tolerated during adrenal pheochromocytoma, and laparoscopic surgery does not increase the risk of adrenal pheochromocytoma. Because of its small damage and rapid recovery, laparoscopy can be the first choice for pheochromocytoma surgery.
【作者单位】： 温州医科大学附属东阳医院泌尿外科;浙江大学附属第一医院泌尿外科;
【分类号】：R736.6
[Abstract]:Objective to investigate the effect of pneumoperitoneum and laparoscopy on hemodynamics in adrenal pheochromocytoma. Methods the clinical data of 101 cases of pheochromocytoma treated by operation from April 2004 to May 2013 were retrospectively analyzed. 49 cases in the laparoscopic group and 52 cases in the open group. After anesthesia intubation, the pneumoperitoneum / operation was established, the tumor was free and the tumor was resected. Arterial systolic pressure (SP),) and diastolic blood pressure (DP),) (DP), heart rate (HR) changes at 5 time points in the resuscitation chamber were compared to compare intraoperative tachycardia (HR100 times / min), hypertensive crisis) (blood pressure 180 / 100 mm Hg),). Incidence of hypotension (SP90 mm Hg), duration of operation, intraoperative bleeding, postoperative hospital stay. Results the incidence of SP,DP,HR and intraoperative hemodynamic instability (at least one of the 3 cases of hypertension crisis, tachycardia or hypotension), tachycardia and hypertension crisis were observed at 5 time points in the two groups. There was no significant difference in the incidence of hypotension (P0.05). In the laparoscopy group, the operative time was short [(99.4 卤36.2) min vs. (, 154.5 卤75.0) min,t=-4.751,P=0.000], and the intraoperative bleeding was less [median 50 (10 1 300) ml vs.300 (50 10 000) ml,Z=-6.529,P=0.000]. The hospital stay was short after operation [(5.8 卤1.9) d vs. (10.8 卤4.6) days]. Conclusion CO2 pneumoperitoneum can be well tolerated during adrenal pheochromocytoma, and laparoscopic surgery does not increase the risk of adrenal pheochromocytoma. Because of its small damage and rapid recovery, laparoscopy can be the first choice for pheochromocytoma surgery.
【作者单位】： 温州医科大学附属东阳医院泌尿外科;浙江大学附属第一医院泌尿外科;
【分类号】：R736.6
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