上腺切除术为feochromocytoma:手术结果和血动力学不稳定的手术前危险因素
Kotaro Suzuki1, Yasuyoshi Okamura1, Yukari Bando1
1Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
概括
腹腔镜上腺切除术用于染细胞瘤 (PCC) 是安全的,与其他上腺瘤相比. 大型瘤和荷尔蒙活动是PCC患者手术内血动力学不稳定 (HI) 的危险因素.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 麻醉学 麻醉学
背景情况:
- 染细胞瘤 (PCC) 的手术切除带来了重大挑战.
- 上腺切除术是PCC的主要治疗方法.
- 术内血动力学不稳定性 (HI) 是PCC手术期间的一个关键问题.
研究的目的:
- 评估PCC上腺切除术的术后结果.
- 为了确定PCC患者手术内HI的危险因素.
主要方法:
- 对571名接受上腺切除术的患者进行了回顾性研究 (2008年4月 - 2023年10月).
- 在PCC (n=92) 和非PCC (n=464) 组之间对腹腔镜上腺切除术结果的比较.
- 对107名PCC患者的HI风险因素的调查,涉及不同的手术方法 (开放式,腹腔镜,机器人辅助).
主要成果:
- 与非PCC患者相比,PCC患者的血液损失较高 (70毫升 vs. 30毫升),但严重并发症 (≥III) 和无死亡率相似.
- 瘤大小≥40毫米,手术前高血压,尿道甲基内弗林≥3倍以上的上限预测HI.
- 对于HI预测因子的几率比:瘤大小2.74,高血压3.91,甲基内弗林3.83.
结论:
- 对PCC进行腹腔镜上腺切除术的安全性与其他上腺瘤相提并论.
- 大型瘤和激素活性疾病是PCC手术内HI的重要风险因素.
- 对于高风险的PCC患者来说,建立最佳的术后管理是至关重要的.
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