后腹腔镜手术治疗嗜铬细胞瘤

Retroperitoneal laparoscopic surgery for pheochromocytoma

目的 探讨后腹腔镜手术治疗嗜铬细胞瘤的适应证及手术安全性。 方法 采用后腹腔镜手术治疗肾上腺嗜铬细胞瘤患者 15例 (双侧 2例 ) ,腹主动脉旁嗜铬细胞瘤 1例。对照组为开放手术治疗的肾上腺嗜铬细胞瘤 16例 ,腹主动脉旁嗜铬细胞瘤 1例。 结果 后腹腔镜手术组 :16例患者行后腹腔镜手术 18例次 ,17例次取得成功 ,1例因术中出血改行开放手术。肿瘤最大径 2 .0～ 6 .5 (3.8± 1.6 )cm。手术时间 4 5～ 15 0 (85± 31)min ,出血量 10～ 10 0 (32± 2 2 )ml。术后吗啡用量 0～ 4 0(12 .5± 7.8)mg ;术后恢复进食时间 1～ 3(1.8± 0 .7)d ;下床活动时间 2～ 3(2 .3± 0 .5 )d ;术后住院时间4～ 9(6 .5± 1.3)d。开放手术组 :肿瘤最大径 1.5～ 6 .0 (4 .3± 1.3)cm。手术时间 90～ 2 4 0 (15 5± 39)min ,出血量 5 0～ 6 0 0 (2 73± 10 5 )ml,9例输血。术后吗啡用量 10～ 12 0 (6 1± 2 4 )mg;术后恢复进食时间 2～ 4 (2 .9± 0 .5 )d ;术后下床活动时间 3～ 6 (4 .8± 0 .7)d ;术后住院时间 8～ 11(8.8± 0 .9)d。 结论 对于有一定腹腔镜手术经验者 ,后腹腔镜手术并不增加嗜铬细胞瘤手术的危险性 ,且具有手术时间短、出血少、创伤小、疼痛轻、康复快等优点。该法有望成为治疗肾上腺嗜铬细胞瘤的首选?

Objective To evaluate the indications and feasibility of retroperitoneal laparoscopic excision of pheochromocytoma. Methods Retroperitoneal laparoscopic excision of pheochromocytoma was performed on 16 patients,including 2 with bilateral adrenal pheochromocytoma,and 1 with para-aortic pheochromocytoma.The control group included 17 patients with pheochromocytoma who underwent open surgery. The postoperative outcomes were compared between the 2 groups. Results The mean largest dimension of the tumor was 3.8±1.6(range,2 to 6.5)cm in laparoscopic surgery group vs 4.3±1.3 (1.5 to 6.0)cm in open surgery group (P>0.05).In the 16 cases,17 retroperitoneal laparoscopic excisions of pheochromocytoma were successful,only 1 was converted to open surgery due to intraoperative bleeding. The mean operative time was 85±31 (range,45 to 150) min in laparoscopic surgery group vs 155±39 (90 to 240) in open surgery group (P<0.001).The mean volume of blood loss was 32±22 (10 to 100) ml with no blood transfusion in laparoscopic surgery group vs 273±105 (50 to 600)ml,with 9 patients receiving blood transfusion,in open surgery group(P<0.001).The mean analgesic(morphine equivalents)consumption was 12.5±7.8 (0 to 40)mg in laparoscopic surgery group vs 61±24(10 to 120)mg in open surgery group (P<0.001).Postoperative hospital stay was 6.5±1.3(4 to 9)day in laparoscopic surgery group vs 8.8±0.9(8 to 11)day in open surgery group(P<0.001). Conclusions Based upon the experience and skills of the surgeons, retroperitoneal laparoscopic surgery for pheochromocytoma is feasible and safe,with no increase in the operation risks.Because of its less traumatic and more rapid recovery,retroperitoneal laparoscopic surgery can be considered the preferred choice for pheochromocytoma.