腹腔镜嗜铬细胞切除术的麻醉方法探讨.doc

腹腔镜嗜铬细胞瘤切除术的麻醉方法探讨 钟锦秀 广东省高州市人民医院麻醉科（525200） 【摘要】 目的 探讨适合腹腔镜肾上腺嗜铬细胞瘤切除手术的麻醉方法。方法 24例腹腔镜嗜铬细胞瘤切除手术患者，随机分为两组：全麻组（A组）和全麻+硬膜外组（B组），每组12例。观察2组患者术中血流动力学变化和并发症的发生率。结果 两组患者在肿瘤切除前后均出现明显的血流动力学变化，但B组血压、心率波动明显小于A组(P＜0.05)，麻醉清醒及拨管时间、并发症的发生率均明显少于A组(P＜0.05)。结论 全麻+硬膜外阻滞应用于腹腔镜嗜铬细胞瘤切除手术麻醉，术中血流动力学波动范围小，并发症少，是一种较好的麻醉方法。 【关键词】腹腔镜;嗜铬细胞瘤;麻醉;血流动力学 Investigate the anesthetic way of laparoscopic adrenalectomy for pheochromocytoma　 ZHONG Jin Xiu. Department of Anesthesiology, GAO-ZHOU PEOPLE Hospital . Guang-Dong 525200 CHINA 【Abstract】Objective To investigate the anesthetic way of laparoscopic adrenalectomy for pheochromocytom.Methods Twenty-four patients were divided randomly into two groups with 12 in each group.Group A underwent laparoscopic adrenalectomy for pheochromocytom under general anesthesia,while group B received the operation under general anesthesia combined with extradural anesthesia.Among all the patients,hemodynamic changes and the complication rate were observed.Results During the whole surgery,distintive hemodynamic changes were present in both groups,but the fluctuation of blood pressure and heart rate in group B were apparently lower than those in group A（P＜0.05).Besides,compared with group A,not only din it take less time for the patients of group B to become comscious after anesthesia,but also time of decamnidation was shorten,with lower complication rate.Conclusinon The application of general anesthesia combined with extradural anesthesia in laparoscopic adrenalectomy for pheochromocytom is a better choice with lower hemodynamic changes and complication rate . 【Key words】Laparoscopic;Pheochromacytoma;Anesthesia;Hemodynamic changes 近年来微创外科的发展腔镜技术不断进步腹腔镜用于治疗肾上腺嗜铬细胞瘤在临床上已逐渐成为主要的治疗手段之一.2±8.1）岁，体重45~76（56.1±9.9）kg，病程7天～10 年，平均（28.4±3.2）月。术前ASA分级为Ⅰ～Ⅱ级。术前经B超、CT或MRI及内分泌检查确诊为肾上腺嗜铬细胞瘤，术后亦经病理证实。均为单侧嗜铬细胞瘤，其中左侧8例，右侧14例，肿瘤直径3.5～5.6cm。16例有持续高血压病史,8例有阵发高血压病史。血压波动范围120～210/95～140mm Hg；心电图提示ST段改变3例，窦性心动过速6例；合并高血糖症2例，经药物控制后空腹血糖8.0mmol/L。实验室检查:血儿茶酚胺和尿VMA正常2例，升高22例，其中9例轻度升高，5例升高