腹腔镜嗜铬细胞瘤围术期麻醉和管理

Anesthesia and Perioperative Management in Laparoscopic Adrenalectomy for Pheochromocytoma

目的与开腹手术比较总结腹腔镜下嗜铬细胞瘤切除术围术期的麻醉和管理。方法选择10例腹腔镜下嗜铬细胞瘤切除术患者与10例开腹嗜铬细胞瘤切除术患者,观察人工气腹前(开腹组手术开始前)、人工气腹后20min(开腹组手术切皮后20min)、分离肿瘤时和肿瘤切除后血液动力学变化,使用血管活性药的情况,术中输液量,手术时间及住院天数。结果与人工气腹前比较,腹腔镜组患者在人工气腹后20min、分离肿瘤时平均动脉压(MAP)明显增高(P<0.05),而肿瘤切除后平均动脉压明显降低(P<0.05),分离肿瘤时的心率(HR)较插管后明显增快(P<0.05)。与手术开始前比较,开腹组患者分离肿瘤时平均动脉压明显增高(P<0.05),而肿瘤切除后平均动脉压明显降低(P<0.05),分离肿瘤时的心率明显增快(P<0.05)。两组患者各时间点的平均动脉压和心率差异均无统计学意义。两组使用降压药、升压药例数差异无统计学意义。比较两组患者术中输液量、手术时间差异均无统计学意义。腹腔镜组住院天数与开腹组比较,有减少的趋势,但差异无统计学意义。结论腹腔镜下嗜铬细胞瘤切除术中,麻醉所承担的风险与开腹手术相似,但创伤小,住院天数有减少的趋势。

Objective To investigate the anesthesia and perioperative management in laparoscopic adrenalectomy for pheochromocytoma in comparison with traditional adrenalectomy. Methods Ten patients receiving laparoscopic adrenalectomy for pheochromocytoma under general anesthesia were allocated into laparscope group（ group L）, and another 10 patients receiving traditional adrenalectomy were allocated into control group（ group C）. Hemodynamic changes, using of vasoactive drugs, fluid infusion, duration of surgery and hospitalization days in each group were compared. Results In both groups, comparing with those at the time point of intubation, mean arterial blood pressure（MAP） increased 20 minutes after artificial pneumoperitoneum and during the period of severing the tumor（ P 〈 0.05 ）; MAP decreased significantly after excision of the tumor（ P 〈 0.05 ） as compared with those at intubation ; heart rate （HR） also increased during the period of severing the tumor（ P 〈 0.05 ）. There was no difference between two groups in MAP and HR at each time point. There was no difference between two groups in the usage of vasoactive drugs ; as well as no differences in fluid infusion and duration of surgery in the two groups. Hospitalization days were fewer in group L than in group C, but there was no difference statistically. Coaclusioa There is similar risks in anesthesia in laparoscopic adrenalectomy for pheochromocytoma and traditional adrenalectomy. However, patients undergoing laparoscopic surgical procedure recover faster as compared with that of open surgery.