嗜铬细胞瘤手术的术前评估及围术期管理

摘要

Objective To explore perioperative management of pheochromocytoma resection and analyze preoperative related factors for intraoperative hemodynamic fluctuations.Methods 24 patients with an elective laparoscopic pheochromocytoma resection is analysed the correlation between preoperative urine vanilla almond acid (VMA), plasma renin activity (PRA) and angiotensinⅡ, imaging is shown in tumor swell diameter and intraoperative hemodynamicfluctuations; the changes of hemodynamics before and after pneumoperitoneum, the immediate and after separation of the tumor.Results All patients with surgery are completed smoothly, does not appear anesthesia related complications. The significant correlation existed among Intraoperative highest SBP value,minimum MAP value and preoperative urineVMA;intraoperative blood pressurefluctuation frequency are correlated significantly with tumor swell diameter. Compared with before pneumoperitoneum ,at the moment of tumor resection,SBP,DBP,HR increase significantly (P<0.05), after tumor resection, SBP, DBP, HR decrease clearly (P<0.05).Conclusion Full preoperative evaluation and preparation, reasonable perioperative management is the key to the success of Pheochromocytoma resection. There were positive correlation of intraoperative hemodynamicfluctuations and Preoperative some factors including urine (VMA) and imaging is shown in the tumor diameter size.%目的：探讨嗜铬细胞瘤手术的围术期管理并分析可能引起术中血流动力学波动的一些术前相关因素。方法选择行腹腔镜下嗜铬细胞瘤切除术的患者24例，分析患者术前的尿香草基杏仁酸（VMA）,血浆肾素活性,血管紧张素Ⅱ,影像学所示肿瘤最大直径与术中血流动力学波动有无相关关系；以及在气腹前、气腹后、分离肿瘤时、分离肿瘤后血流动力学变化情况。结果所有患者均顺利完成手术，未出现麻醉相关并发症。术中最高收缩压(SBP)值，最低MAP值与术前尿VMA存在显著相关关系，术中血压波动次数与肿瘤最大直径存在显著相关关系。与气腹前相比，气腹后的SBP，肿瘤切除术时的SBP、舒张压(DBP),心率(HR)均明显升高(P＜0.05)；肿瘤切除后，SBP、DBP、HR均明显降低(P＜0.05)。结论充分的术前评估及准备，合理的围术期管理是嗜铬细胞瘤切除术成功的关键。术前尿VMA和影像学所示肿瘤最大直径与术中血流动力学波动存在显著的相关关系。