嗜铬细胞瘤或副神经节瘤患者术后发生严重并发症的影响因素

Influence Factors for Severe Postoperative Complications in Pheochromocytoma or Paraganglioma Patients

目的:探讨嗜铬细胞瘤或副神经节瘤(PPGL)患者术后严重并发症的影响因素。方法:回顾性分析2015年1月1日-2021年1月1日于福建省立医院行手术切除,126例病理确诊为PPGL患者的围手术期资料。收集患者人口学特征、术前合并症、术前检查、术前准备、手术情况及术后并发症情况,根据Clavien-Dindo分级系统将患者分为严重并发症组(SPC组)和无严重并发症组(无SPC组)。比较两组临床特征,分析术后发生严重并发症的影响因素。结果:38例患者发生了Clavien-DindoⅡ级以上严重并发症。与无SPC组相比,SPC组年龄更大,术前D-二聚体、纤维蛋白原降解产物(FDP)及24 h尿香草扁桃酸水平(VMA)更高,肿瘤更大,手术时间更长,术中收缩压波动范围(ΔSBP)及收缩压标准差(SBPSD)更大,低血压时间更长;而术前血红蛋白及白蛋白水平较低(P<0.05)。多因素分析结果表明,患者术前D-二聚体水平(OR=2.29;95%CI:1.264,4.163;P=0.006)、术中SBPSD(OR=1.12;95%CI:1.052,1.197;P<0.001)及术中低血压时间(OR=1.04,95%CI:1.012,1.069,P=0.004)是PPGL患者术后发生严重并发症的独立危险因素,而术前血红蛋白水平为保护因素(OR=0.97,95%CI:0.937,0.997,P=0.030)。结论:术前D-二聚体水平高、血红蛋白水平低、术中SBPSD大及低血压时间长与PPGL患者术后严重并发症的发生密切相关。

Objective:To investigate the influence factors of severe postoperative complications in pheochromocytoma or paraganglioma(PPGL).Method:The perioperative data of 126 patients with pathologically confirmed PPGL who underwent surgical resection in Fujian Provincial Hospital from January 1,2015 to January 1,2021 were retrospectively analyzed.Demographic characteristics,preoperative complications,preoperative examinations,preoperative preparation,intraoperative data,and postoperative complications were collected.Patients were divided into the severe postoperative complication group(SPC group)and non-severe postoperative complication group(non-SPC group)according to the Clavien-Dindo classification system.The clinical characteristics of the two groups were compared and the influencing factors of severe postoperative complications were analyzed.Result:Thirty-eight patients developed severe complications(Clavien-Dindo grade≥gradeⅡ).Compared with non-SPC group,the SPC group was significantly older,had a higher level of preoperative D-dimer,higher fibrinogen degeneration products(FDP)and 24 h urine vanillylmandelic acid(VMA),larger tumor size,longer duration of operation,larger difference between the maximum and minimum systolic blood pressure(ΔSBP),larger standard deviation of systolic blood pressure(SBPSD),longer duration of hypotension,lower hemoglobin concentration and lower albumin level(P<0.05).The results of multivariate analysis showed that,preoperative D-dimer level(OR=2.29;95%CI:1.264,4.163;P=0.006),intraoperative SBPSD(OR=1.12;95%CI:1.052,1.197;P<0.001)and duration of hypotension(OR=1.04;95%CI:1.012,1.069;P=0.004)were independent risk factors for severe postoperative complications;preoperative hemoglobin level was protective factor(OR=0.97;95%CI:0.937,0.997,P=0.030).Conclusion:Higher preoperative D-dimer level,lower hemoglobin level,larger SBPSD,longer duration of hypotension are closely associated with severe postoperative complications in patients with PPGL.