Case report: Retroperitoneoscopic pheochromocytoma removal in an adult with Eisenmenger's syndrome
Case report: Retroperitoneoscopic pheochromocytoma removal in an adult with Eisenmenger's syndrome
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DOI：
10.1007/bf03017207
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发表时间：
2008-05-01
期刊：
影响因子：
--
通讯作者：
Luke, Patrick P.
中科院分区：
文献类型：
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作者：
Bellingham, Geoff A.;Dhir, Achal K.;Luke, Patrick P.
目的：需要手术治疗的未矫正或姑息的复杂先天性心脏病患者可以从腹腔镜技术中获益，但腹膜后吹气可能使其血流动力学不稳定。已经研究了腹膜后吹气过程中心肺生理学的变化，但没有病例详细说明这种方法在先天性心脏病患者中的应用。我们提出了一个病例的嗜铬细胞瘤切除术通过后腹腔镜在一个姑息性的，复杂的心脏lesions.Clinical特点：一个28岁的女子被承认为去除嗜铬细胞瘤通过后腹腔镜。她心脏病的主要特征是完全性房室管缺损。她最终发展为艾森曼格综合征，并成为慢性紫绀。腹膜后注入CO2气体不会改变血流动力学变量。峰值气道压力显著增加，可能是由于吹入的扩张效应，或由于增加每分钟通气量以减少外源性CO2。动脉CO2保持稳定，但呼气末和动脉水平之间明显增加。肿瘤操作导致全身性（可能还有肺动脉）高血压，加重心室功能障碍。这种情况导致房室瓣反流，如经食管超声心动图所示，肺血流减少，随后去饱和。这些变化在抗高血压药物治疗后消退。病人的气管拔管术后4小时，她恢复顺利。结论：心肺生理改变的患者可以耐受后腹腔镜注气与相对的血流动力学稳定。需要适当使用短效血管活性药物，积极监测PaCO2和血流动力学变量。
Purpose: Patients with uncorrected or palliated, complex congenital heart lesions requiring surgery can benefit from laparoscopic techniques, but retroperitoneal insufflation may render them hemodynamically unstable. Alterations in cardiopulmonary physiology during retroperitoneal insufflation have been studied, yet there are no cases detailing this approach in patients with congenital heart lesions. We present a case of a pheochromocytoma removal via retroperitoneoscopy in a patient with a palliated, complex heart lesion.Clinical features: A 28-yr-old woman was admitted for removal of a pheochromocytoma through retroperitoneoscopy. The main feature of her heart disease was a complete atrioventricular canal defect. She eventually developed Eisenmenger's syndrome and became chronically cyanotic. Retroperitoneal insufflation with CO2 gas did not change hemodynamic variables. Significant increases in peak airway pressures were encountered, possibly due to the distending effects of insufflation, or due to increasing the minute ventilation to reduce exogenous CO2. Arterial CO2 remained stable, but a significant increase between end-tidal and arterial levels became apparent with insufflation. Tumour manipulation led to systemic (and possibly pulmonary) hypertension, which exacerbated ventricular dysfunction. This condition resulted in atrioventricular valve regurgitation, as seen on transesophageal echocardiography, and diminished pulmonary blood flow with subsequent desaturation. These changes resolved with anti hypertensive medications. The patient's trachea was extubated four hours postoperatively, and she recovered uneventfully.Conclusion: Patients with altered cardiopulmonary physiology may tolerate retroperitoneoscopic insufflation with relative hemodynamic stability. Appropriate use of short-acting, vasoactive drugs and aggressive monitoring of PaCO2 and hemodynamic variables is required.