经典肾上腺切除术与单孔肾上腺切除术的术中血流动力学比较

S. Shikhmagomedov, D. V. Rebrova, M. A. Alekseev, L. M. Krasnov, E. A. Fedorov, I. K. Chinchuk, R. Chernikov, V. F. Rusakov, I. Sleptsov, I. Sablin, O. V. Kuleshov
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In this study, the influence of these options of retroperitoneoscopic access on intraoperative hemodynamic control was evaluated.AIM: Comparison of treatment results and intraoperative hemodynamic parameters of patients with adrenal pheochromocytomas operated with single-port and three-port retroperitonescopic access options.MATERIALS AND METHODS: A retrospective single-center cohort study was conducted on a sample of patients initially operated for pheochromocytoma at the Pirogov St. Petersburg State University High Medical Technology Clinic from October 2015 to February 2020 with intraoperative invasive hemodynamic control using PiCCO+ systems.RESULTS: 47 patients were examined, 24 of whom underwent single–port adrenalectomy (included in the first group), 23 — three-port (second group). 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引用次数: 0

摘要

背景:嗜铬细胞瘤(PCC)是一种来自肾上腺髓质绒毛组织的肿瘤,能够过度分泌儿茶酚胺。由于嗜铬细胞瘤具有激素活性,它的一个重要特征是在手术治疗过程中可能出现血流动力学参数的突然变化。目前,腹膜后腔镜入路在肾上腺绒毛膜细胞瘤的手术治疗中越来越流行。在临床实践中,上述入路有两种变体:经典(三孔)和单孔。目的:比较单孔和三孔腹膜后入路肾上腺嗜铬细胞瘤患者的治疗效果和术中血流动力学参数。材料与方法:对2015年10月至2020年2月期间在皮拉戈夫-圣彼得堡国立大学高等医学技术诊所接受嗜铬细胞瘤初次手术的患者样本进行了回顾性单中心队列研究,术中使用PiCCO+系统进行有创血流动力学控制。结果:47名患者接受了检查,其中24人接受了单孔肾上腺切除术(第一组),23人接受了三孔肾上腺切除术(第二组)。第二组的平均肿瘤大小更大(40.12±9.3 和 56.7±21.5,P0.05)。第二组的收缩压升高超过 180 mm Hg 的情况更频繁(P=0.03),但两组的总持续时间无显著差异(P>0.05)。释放肾上腺时的术中降压药物用量和压迫肾上腺中心静脉后的血管加压药物用量相似。第一组和第二组压迫中心静脉后的血压没有明显差异(P>0.05)。结论:在麻醉团队和手术医生有足够经验的情况下,单孔腹膜后腔镜入路的改造不会导致血流动力学控制和手术效果的恶化,在嗜铬细胞瘤的手术治疗中安全有效。
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Comparison of intraoperative hemodynamics in classical and single-port adrenalectomy
BACKGROUND: Pheochromocytoma (PCC) is a tumor from the chromaffin tissue of the adrenal medulla, capable of hyperproduction of catecholamines. An important feature of pheochromocytoma, due to its hormonal activity, is the threat of sudden changes in hemodynamic parameters during surgical treatment. Retroperitoneoscopic access is currently becoming increasingly popular in the surgical treatment of chromaffin tumors of the adrenal glands. In clinical practice, two variants of the mentioned access are used: classic (three-port) and single-port. In this study, the influence of these options of retroperitoneoscopic access on intraoperative hemodynamic control was evaluated.AIM: Comparison of treatment results and intraoperative hemodynamic parameters of patients with adrenal pheochromocytomas operated with single-port and three-port retroperitonescopic access options.MATERIALS AND METHODS: A retrospective single-center cohort study was conducted on a sample of patients initially operated for pheochromocytoma at the Pirogov St. Petersburg State University High Medical Technology Clinic from October 2015 to February 2020 with intraoperative invasive hemodynamic control using PiCCO+ systems.RESULTS: 47 patients were examined, 24 of whom underwent single–port adrenalectomy (included in the first group), 23 — three-port (second group). The average tumor size in the second group was larger (40.12±9.3 and 56.7±21.5, p<0.05), presumably, in this regard, the average duration of surgery was statistically significantly higher (73±21.5 and 111.7±36.1, p<0.05). The body mass index (BMI) of patients in the two groups did not differ statistically significantly. Intraoperatively measured values of maximum and minimum mean systolic and diastolic blood pressure, the number of episodes of increased diastolic blood pressure above 120 mmHg and their duration did not differ statistically in both groups (p>0.05). Episodes of increased systolic blood pressure above 180 mm Hg were more frequent in the second group (p=0.03), but their total duration in the two groups was without significant differences (p>0.05). Intraoperative consumption of antihypertensive drugs during the release of the adrenal gland and vasopressor drugs after compression of the central vein of the adrenal gland were similar. Blood pressure after compression of the central vein in the first and second groups did not differ significantly (p>0.05). No deaths and postoperative complications were registered in both groups.CONCLUSION: Single-port modification of retroperitoneoscopic access with sufficient experience of the anesthesiological team and the operating surgeon does not lead to deterioration of hemodynamic control and operation results, being safe and effective in the surgical treatment of pheochromocytoma.
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