两种手术方式对后腹腔镜下肾上腺嗜铬细胞瘤切除术血液动力学影响的对比研究

Intraoperative hemodynamic effects in patients undergoing retroperitoneal laparoscopic adrenalectomy for pheochromocytomas performed with different methods

目的探讨不同手术方式对后腹腔镜下肾上腺嗜铬细胞瘤切除术血液动力学变化的影响。方法回顾性分析我院自2002年3月至2010年12月完成的58例后腹腔镜下肾上腺嗜铬细胞瘤切除术,比较术中不同的后腹腔建立方法、CO2气腹压力、肾上腺中央静脉处理策略对血液动力学变化的影响。结果在后腹腔建立期,与术前相比,A组的MAP(平均动脉压)和HR(心率)明显增高、增快(P<0.05),B组无明显改变;在肿瘤游离期,两组的MAP和HR都明显增高、增快(P<0.05),B组变化程度低于A组(P<0.05);在肿瘤切除后期,两组都有MAP降低和HR增快(P<0.05),B组的变化程度比A组低(P<0.05)。两组各期CVP(中心静脉压)无明显改变(P>0.05)。结论后腹腔镜下嗜铬细胞瘤切除术中采用指扩法、低CO2气腹压力、优先处理肾上腺中央静脉在后腹腔建立期、肿瘤游离期、肿瘤切除后期对平均动脉压和心率的影响较小,血液动力学环境较稳定。

Objective To explore the intraoperative hemodynamic effects in patients undering retroperitoneal laparoscopic adrenalectomy for pheoehromoeytomas with different operative methods. Meth- ods Retrospective analysis was performed for 58 consecutive patients who underwent retroperitoneal la- paroscopie adrenalectomy for pheochromocytomas between March 2002 to December 2010. The procedures were performed using different methods, which involved the retroperitoneum building, the pressure of carbon dioxide pneumoperitoneum and the strategy to handling the adrenal main vein. The intraoperative hemody- namic parameters were compared. Results There was significant raise of MAP（mean arterial pressure） and HR（heart rate） on stage of retroperitoneum building in group A. During stage of mobilizing tumor, there was a significant raise of MAP and HR in 2 groups and a significant higher level in group A compared With group B. On anaphase tumor excising, there were significant decrease of MAP and raise of HR in 2 groups and a significant higher level in group A compared with group B. There was no significant difference of CVP （central venouspressure） in each stage of 2 groups. Conclusions Finger-dilation, low pneumoperi- toneum pressure and handling the adrenal main vein first during retroperitoneal laparoseopie adrenalectomy for pheochromocytomas demonstrated significantly less effects on mean blood pressure and heart rate on various stages of building retroperitoneal space, mobilizing tumor and anaphase tumor excising, and the hemodvnamic environment would be more stable.