ObjectiveTo Summarize and analyze the pheochromocytoma complications of surgery patients and its influential factors, in order to provide a basis for preoperative assessment and postoperative support treatment for the patients. MethodsWe reviewed the clinical data of 88 patients with pheochromocytoma from West China Hospital between January 2010 and December 2012. Among them, 35 had complications (complication group), and the other 53 had no complications (non-complication group). We analyzed preoperative blood catecholamine levels, preoperative preparation, tumor size, tumor location and surgical approach in all these patients. ResultsThere were 16 patients (45.7%) with bilateral adrenal tumors (χ2=19.976, P<0.001), and 9 patients (25.7%) with extra-adrenal tumors (χ2=7.380, P=0.007) in the complication group, significantly higher than 3 (5.7%) and 2 (3.8%) patients respectively in the non-complication group. The diameter of tumor in the complication group was (8.33±3.69) cm, which was significantly higher than that in the non-complication group[(4.32±3.12) cm] (t=5.484, P<0.001). The risk factors for complications in patients undergoing pheochromocytoma surgery included bilateral adrenal tumors (OR=10.316, P<0.001), extraadrenal tumors (OR=8.827, P=0.008), diameter of the tumor longer than 6 cm (OR=94.937, P<0.001), laparotomy (OR=40.727, P<0.001) and long time surgery for more than three hours (OR=312.000, P<0.001). ConclusionPatients who develop complications after pheochromocytoma surgery usually have bigger, and bilateral adrenal or extraadrenal tumors. Patients whose surgery is laparotomy or longer than three hours may also have more complications.These influential factors should be considered in future comprehensive treatment in order to achieve a good prognosis.
Objective To investigate the indications, procedures, risks and efficacy of extracorporeal membrane oxygenation (ECMO) in bronchoscopic interventional surgery for patients with severe airway stenosis. Methods Retrospective analysis was performed on 6 patients with severe airway stenosis treated by bronchoscopic surgery under ECMO in West China Hospital from January 2018 to July 2021, and the experience of application was summarized in combination with 23 relevant literatures retrieved. Results Six patients on ECMO successfully completed bronchoscopic interventional surgery with satisfactory intraoperative oxygenation and no obvious hemostasis difficulties were observed. ECMO placement was as an emergency medical countermeasure in 3 patients while the other 3 patients were as preventive purpose. Following treatment, the shortness of breath index and mMRC score decreased and the patients were cured and discharged. During hospitalization, 3 patients had lower extremity deep vein thrombosis, and 1 patient with lower extremity swelling and pain, which was relieved after treatment with low molecular weight heparin. During discharge follow-up, 1 patient died due to airway stenosis, pulmonary infection, and subarachnoid hemorrhage secondary to cardiopulmonary resuscitation, while the other 5 patients did not show any worsening of dyspnea. Combined with the retrieval of 46 similar cases reported in the literature before 2020, it was concluded that these patients who met the application indications of ECMO and followed the shutdown procedure had a good prognosis and controllable risk. Conclusions ECMO can ensure the safety of patients with severe airway stenosis who need undergoing bronchoscopic interventional surgery for patients, improve the success rate of the operation and do not significantly increase the risk of bleeding. However, ECMO is difficult to operate and requires professional team management. Therefore, it is essential to master the indications of application, implement strict withdrawal procedures and necessary monitoring to improve the patient's cure rate and reduce the occurrence of adverse events.