后腹腔镜手术与开放手术治疗肾上腺嗜铬细胞瘤疗效比较

Comparison of clinical efficacy between retroperitoneal laparoscopic surgery and open adrenalectomy for adrenal pheochromocytoma

目的：对比分析后腹腔镜手术与开放手术治疗肾上腺嗜铬细胞瘤的疗效,评价后腹腔镜手术治疗肾上腺嗜铬细胞瘤的临床价值。方法：选择本科收治的48例单侧肾上腺嗜铬细胞瘤患者,按患者意愿和手术者经验分别选择后腹腔镜手术（23例）和开放手术（25例）。比较2组肾上腺嗜铬细胞瘤患者临床资料,统计分析2种术式在手术时间、术中出血量、术中血压控制情况、术后住院时间及术后并发症发生率等方面的差异。结果：2组患者手术均获得成功。后腹腔镜组和开放手术组患者手术时间分别为（60±25）min和（100±40）min;出血量分别为（42±16）mL和（156±45）mL;术中血压分别为（160±10）mmHg和（165±55）mmHg;术后住院时间分别为（5.2±1.2）d和（7.4±1.6）d。后腹腔镜组手术时间、术中出血量、术中血压及术后住院时间与开放手术组比较,差异均有统计学意义（均P〈0.01）。术后2组患者均无重大并发症发生。术后病理报告均为肾上腺嗜铬细胞瘤。术后随访时间6~48个月,2组患者临床症状消失,肿瘤局部无复发。结论：后腹腔镜肾上腺嗜铬细胞瘤切除术与开放手术比较出血少、创伤小、恢复快,明显优于开放手术,是治疗肾上腺嗜铬细胞瘤安全有效的方法。

Objective To investigate the clinical efficacy of retroperitoneal laparoscopic surgery of adrenal pheochromocytoma by comparing the differences between open and retroperitoneal laparoscopic surgery of adrenal pheochromocytoma. Methods Based on patients＇ requirements and surgeon＇s experience, 48 patients with unilateral adrenal pheochromocytoma were divided into retroperitoneal laparoscopic group （n= 23）and open surgery group （n=25）. The clinical efficacies in two groups were compared and the differences between them in operation time, blood loss, intraoperative blood pressure control, postoperative hospitalization time and the incidence of postoperative complications were investigated. Results The operation in two groups was successful. In retroperitoneal laparoscopic group and open surgery group, the operation time were （60± 25） min and （100± 40） min, the blood loss were （42± 16） mL and （156±45） mL, the blood pressure in operation were（160! 10） mmHg and （165±55） mmHg, the postoperative hospitalization time were （5.2± 1.2） d and （7.4± 1.6） d. there were significant differences between two groups （all P 〈0.01 ）. There were no major postoperative complications. All the 48 cases were pathologically diagnosed as pheochromoeytoma. All patients were followed up for 6 - 48 months, their clinical symptoms disappeared. No tumor recurrences developed. Conclusion Retroperitoneal laparoscopic surgery is superior to open surgery in treating adrenal pheochromocytoma patients, which has less bleeding, less trauma and quicker recovery. It is therefore a safe and effective method in treating pheochromocytoma.