VHL综合征与非VHL患者行嗜铬细胞瘤切除术围术期临床麻醉比较

The comparison of perioperative clinic anesthesia of VHL syndrome and non-VHL patients undergoing pheochromocytoma resection

目的比较VHL综合征与非VHL患者行嗜铬细胞瘤切除术的围术期手术及麻醉特点。方法回顾性分析2009-01-01至2014-12-31期间于北京协和医院行嗜铬细胞瘤切除术的患者50例,包括12例VHL综合征及38例非VHL患者,收集临床资料,特别关注临床表现、术前检查、准备时间、麻醉管理、手术时间及术后住院时间等围术期相关临床资料。结果与非VHL患者相比,VHL综合征患者行嗜铬细胞瘤切术年龄明显较小,肿瘤多发,并以去甲肾上腺素大幅升高为特点,药物准备时间长,手术时间和住院时间也明显延长(P<0.05),但术中血流动力学波动及预后方面无明显差异。结论 VHL综合征患者的嗜铬细胞瘤发病年龄小,以多发为主,肿瘤功能较强,手术时间长、风险高,围术期优化策略和充分的药物准备是保证手术安全的重要措施。

Objective To compare the experience of perioperative management and anesthesia in VHL syndrome and non-VHL patients undergoing pheoehromocytoma resection. Methods 50 patients scheduled for surgical removal of pheoehromocytoma in PUMC Hospital from 2009-01-01 to 2014-12-31 were included in this retrospective analysis. Among them, 12 patients were diagnosed with VHL syndrome, others were non-VLH patients. We focused on the clini- cal records, especially clinical manifestation, preoperative preparation, intraoperative anesthetic management, opera- tion duration and postoperative hospital stay. Results Comparing with non-VHL patients, VHL syndrome patients undergoing pheochromocytoma resection surgery were much younger, with multiple pheochromocytoma and a signifi- cantly increased norepinephrine release. The drug preparation period was much longer, as well as the operative time and hospital stay （P 〈 0. 05）. But no statistical difference existed in the intraoperative hemodynamic fluctuation and the outcomes of the patients. Conclusions VHL syndrome patients mainly present with multiple pheochromocytoma which has more aggressive function. Since the long operation duration and high risk, the optimization of perioperative management and adequate drug preparation are the key factors to ensure the operation safety.