没有术前医疗准备的副神经节瘤腹腔镜肾上腺切除术中血流动力学不稳定性与非分泌性肿瘤的比较

Intraoperative hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma without preoperative medical preparation compared with nonsecreting tumor

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SURGERY

影响因子:2.7

分区:医学2区 / 外科2区

发表日期:2025 Jan

作者: Claire Nomine-Criqui, Amélie Delens, Phi-Linh Nguyen-Thi, Florence Bihain, Nicolas Scheyer, Philippe Guerci, Thomas Fuchs-Buder, Laurent Brunaud

DOI: 10.1016/j.surg.2024.09.017

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摘要

控制肾上腺切除术中副神经节瘤的血流动力学特征被建议以最小化围手术期心血管并发症。然而，在非副神经节瘤指征的肾上腺切除术中也观察到血流动力学不稳定的发作。本研究旨在比较无术前医疗准备的副神经节瘤单侧肾上腺切除术期间的血流动力学不稳定评分与非分泌性肿瘤的评分。这是一项观察性研究，采用前瞻性手术中血流动力学数据（每20秒记录一次）和回顾性分析。在研究期间，连续纳入60名患者（副神经节瘤30例，非分泌性肿瘤30例），手术总时间中数据采集的中位次数为318次（四分位距257-388）。血压目标范围外的平均累计时间占总手术时间的百分比为13.3%（收缩压>160 mm Hg）与6.8%（P=0.01），而平均动脉压<60 mm Hg的时间分别为2.4%与2.8%（P=非显著）。副神经节瘤组与非分泌性肿瘤组的血流动力学不稳定评分中位数分别为33（四分位距27-43）和20（四分位距11-26）（P<.01）。在每组患者中，有无长期抗高血压治疗的患者血流动力学不稳定评分无显著差异（P=非显著）。平均住院天数为2.0±1.5天，30天内并发症发生率为6.6%（4/60），两组间差异无统计学意义。尽管无术前医疗准备的副神经节瘤患者手术中血流动力学不稳定仍较多，但两组均出现类似的低血压发作。这些数据强调了深入理解术前医疗准备在副神经节瘤患者中的作用的必要性。

Abstract

Control of hemodynamic features during adrenalectomy for pheochromocytoma is recommended to minimize perioperative cardiovascular complications. However, episodes of intraoperative hemodynamic instability have been observed during adrenalectomies with other indications than pheochromocytoma. The objective of this study was to compare the hemodynamic instability score assessed during unilateral adrenalectomy for pheochromocytoma without preoperative medical preparation to hemodynamic instability score in nonsecreting tumor.This was an observational study with prospective intraoperative hemodynamic data collection (every 20 seconds) and retrospective analysis.During the study period, 60 consecutive patients (30 pheochromocytomas vs 30 nonsecreting tumors) were included with a median number of data collections during total procedure time of 318 (interquartile range, 257-388). Mean cumulative intraoperative time outside the target blood pressure range expressed as a percentage of total procedure time was 13.3% vs 6.8% for systolic blood pressure >160 mm Hg (P = .01) and 2.4% vs 2.8% for mean arterial pressure <60 mm Hg (P = ns), respectively. The median hemodynamic instability score during total procedure time was 33 (interquartile range, 27-43) and 20 (interquartile range, 11-26) in the pheochromocytoma and nonsecreting tumor group, respectively (P < .01). Hemodynamic instability score were similar in patients with compared with without long-term antihypertensive treatment in each patient group (P = ns). The mean length of hospital stay was 2.0 ± 1.5 days, and 30-day morbidity rate was 6.6% (4/60) with no significant difference observed between both groups.Although intraoperative hemodynamic instability remains greater in the pheochromocytoma group without preoperative medical preparation, both groups have similar hypotensive episodes. These data highlight the need to better understand the role of preoperative medical preparation in pheochromocytoma patients.