Objective: To investigate the effects of intraoperative hemodynamic instability on postoperative complications of laparoscopic surgery for pheochromocytoma. Methods: It was a retrospective cohort study. According to inclusion/exclusion criteria, adult patients underwent laparoscopic surgery for pheochromocytoma from January 2005 to December 2017 in Peking University First Hospital were enrolled in this study. Eligible patients were divided into two groups by evidence of postoperative complications to find out the effects of intraoperative hemodynamic instability and its' effects on other prognostic indices. The normally distributed continuous variables were compared between two groups by Student's t test, Mann-Whitney U test were used for the comparison for non-normally distributed continuous variables and χ(2) test for categorical variables. Results: A total of 198 patients were finally enrolled in this study, including 87 males and 111 females with an average age of (47±15) years. Postoperative complications occurred in 17 patients with an incidence of 8.6%, and intraoperative hemodynamic instability occurred in 45 patients (22.7%). It was found that history of stroke[odds ratio (OR)=13.387, 95% confidence interval (CI): 2.284-78.460, P=0.004], intraoperative hemodynamic instability (OR=3.351, 95%CI: 1.119-10.039, P=0.031) and intraoperative positive fluid balance (for each additional 100 ml) (OR=1.087, 95%CI: 1.031-1.146, P=0.002)were the independent risk factors of postoperative complications of laparoscopic surgery for pheochromocytoma. Furthermore, more postoperative complications, higher rate of admitting to ICU and longer hospital stay was found in patients with hemodynamic instability. Conclusion: Intraoperative hemodynamic instability is an independent risk factor for postoperative complications of laparoscopic surgery in patients with pheochromocytoma, and it associates with more postoperative complications and higher rate of admitting to ICU.
目的： 探讨腹腔镜嗜铬细胞瘤切除术中血流动力学波动对术后并发症的影响。 方法： 本研究为回顾性队列研究，根据入选/排除标准，收集自2005年1月至2017年12月入住北京大学第一医院行腹腔镜嗜铬细胞瘤切除术的患者资料。以患者是否发生术后并发症进行分组，以明确血流动力学波动对术后并发症的影响，并进一步分析其对术后其他预后指标的影响。正态分布计量资料的组间比较采用独立样本t检验，非正态分布计量资料或等级资料比较采用非参数检验。 结果： 本研究最终纳入198例腹腔镜嗜铬细胞瘤手术患者，男87例，女111例，平均年龄(47±15)岁；其中17例(8.6%)发生术后并发症，45例(22.7%)发生血流动力学波动。研究发现脑卒中病史[比值比(OR)＝13.387，95%可信区间(CI)：2.284～78.460，P＝0.004]，术中血流动力学波动(OR＝3.351，95%CI：1.119～10.039，P＝0.031)和术中液体正平衡(每增加100 ml)(OR＝1.087，95%CI：1.031～1.146，P＝0.002)是术后并发症的独立危险因素。进一步分析发现，血流动力学波动患者术后并发症数目更多，重症监护病房(ICU)入住比例显著增加，而住ICU时间和术后住院时间亦表现出延长的趋势。 结论： 术中血流动力学波动为腹腔镜嗜铬细胞瘤切除术后并发症的独立危险因素，同时其还与患者术后更多的并发症数目，更高的ICU入住率显著相关。.
Keywords: Hemodynamic instability; Laparoscopic surgery; Pheochromocytoma; Postoperative complications.