经腹入路腹腔镜下肾上腺嗜铬细胞瘤切除术中肾上腺中央静脉的处理体会

Experience of management of central adrenal vein during laparoscopic resection of pheochromocytoma by transabdominal approach

目的比较经腹入路腹腔镜下肾上腺嗜铬细胞瘤切除术中不同时机处理肾上腺中央静脉对手术安全性的影响。方法﹑选取2012年6月—2019年6月空军军医大学西京医院收治的43例肾上腺嗜铬细胞瘤患者,根据手术方式不同将其分为两组;观察组(n=22)和对照组(n=21)。观察组患者在完全游离肿瘤前先结扎肾上腺中央静脉,对照组患者在游离完肿瘤后再结扎肾上腺中央静脉。比较两组患者在开始麻醉前、结扎肾上腺中央静脉前和切除肿瘤后的不同时段血肾上腺素、去甲肾上腺素水平变化,以及在手术时间,术中出血量,住院时间、术中血压剧烈波动例数﹑频次等方面有无差别。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ^2检验。结果两组患者的平均手术时间.术中出血量,术中血压出现剧烈波动例数和术后平均住院时间比较,差异无统计学意义(P>0.05);观察组和对照组患者术中血压出现剧烈波动的频次分别为19,47次,差异具有统计学意义(P<0.05)。两组患者的血肾上腺素﹑去甲肾上腺素水平在麻醉前及肿瘤切除后比较,差异无统计学意义(P>0.05);但在结扎中央静脉前,观察组和对照组患者的肾上腺素水平分别为(572.1±282.1)pg/mL和(935.6±417.5)pg/mL,去甲肾上腺素水平分别为(8347.9±4103.6)pg/mL和(13695.7±3205.3)pg/mL,差异均具有统计学意义(P<0.05)。结论﹑尽早结扎肾上腺中央静脉有利于提高经腹入路腹腔镜手术治疗肾上腺嗜铬细胞瘤的手术安全性。

Objective To compare the safety of adrenal central vein treated at different times inlaparoscopic adrenal pheoechronocytoma resection through abwlominal approuch.Methods A study was conductedon 43 patients with adrenal pheochromocytoma admitted to Xijing Hospital,Air Forve Military Medical University from June 2012 to June 2019.The includled patients were divided into two groups accordling to the surgical method:observation group(n=22)and control grup(n=21).The patients of ohservation group were ligated the centraladvenal vein before the tumor was completely isolatedl,and the pxatients of control proup were ligated the centraladvenal vein after the tumor was isolatevl.The changes of blood catecholamine levels before anesthesia,beforecentral adrenal vein ligation,and after tumor resection were cormpared between the two groups,as well as thedifferences in operative time,intraoperative bloodl loss,hospital stay,mumber of cases with intraoperative bloodpressure fluctuations anud frexquency.Measurement dlata were expressed as mean±standard deviation(Mean±SD),comparison between groups was by t-test;commparison of count data between groups was by Chi-square.Results There was no significant difference in the mean operation time,the mean hospital stay,intraoperative blood loss,number of cases with dramatic blood presure fluctuations between two grnoups(P>0.05).The frequency of severefluctuation of intraoperative blood pressure in observation group and control group was 19 times and 47 times,respectively,the difference was statistically significant(P<0.05).There was no significant difference in the bloodepincphrinc and norepincphrinc levels between the two groups before ancsthesia and after tumor resection(P>0.05).However,hefore ligation of the central vein,the epinephrime corncentratioms in the okservation group andthe control group were(572.1±282.1)pg/mL.and(935,6±417.5)pg/mL,respeetively,the noralrenalineconcentrations were(8347.9±4103.6)pg/mL and(13695.7±3205.3)pg/mL,respectively,the differencewas statistically significant(P<0.05).Conclusion Early ligation of the adrenal central vein can improve thesafety of the laparoscopic approach to ardrenal poheochromocytoma.