后腹腔镜下肾上腺嗜铬细胞瘤切除术56例体会

Retroperitoneoscopic adrenalectomy for pheochromocytoma （report of 56 cases）

目的探讨后腹腔镜下手术治疗肾上腺嗜铬细胞瘤的有效性和安全性。方法行后腹腔镜肾上腺嗜铬细胞瘤切除术56例。肿瘤位于左侧24例、右侧30例、双侧2例。肿瘤直径1．5～10．0cm，平均（4．5±2.0）cm。主要临床表现为高血压者45例；无高血压者5例，主诉心悸、恶心、呕吐、腹痛、消瘦等；无症状经体检发现者6例。56例均行内分泌常规检查和影像学检查。术前常规行扩容、降压及对症处理，术中术后严密监测血压变化并给予相应处理。结果55例手术成功，1例中转开放手术。手术时间（52±22）min，术中估计出血量（74±34）ml．术后住院时间（5±1）d。术中术后未发生重大并发症。术中血压波动≥20rnmHg（1mmHg=0．133kPa）21例。病理报告均为嗜铬细胞瘤。随访5～36个月，36例患者术后2个月内血压恢复正常，9例仍需口服降压药物。肿瘤局部无复发。结论后腹腔镜下肾上腺嗜铬细胞瘤手术具有微创、出血少、恢复快等优点，充分的术前准备、正确的术中操作是手术安全的保证。

Objective To evaluate the efficacy and safety of retroperitoneoscopic adrenalectomy for the treatment of pheochromocytoma. Methods From 2000 to 2005, 58 retroperitoneoscopic adrenalectomies for pheochromocytoma were performed. Thirty tumors were on the right side, 24 were on the left and 2 bilateral. The mean tumor size was （4.5±2.0）cm in diameter （range, 1.5 to 10.0 cm）. Forty-five patients mainly presented hypertension, and 5 cases had no hypertension, with chief complaints of palpitation, nausea, vomiting and abdominal pain, and 6 cases symptomless. The preoperative preparations included modulating blood pressure, expanding blood volume and other measures to treat relative symptoms. The monitor of intra-and post-operative blood pressure fluctuation was performed intensively. Results Fifty-seven operations were completed successfully in 55 patients, with 1 conversion to open surgery. Mean operating time was （52 ± 22） min （range, 25 to 130）. Mean estimated blood loss was （74±34）ml （range 20 to 300）. Mean hospital stay after operation was （5±1）d （range 3 to 9）. There were no major intraoperative complications occurred. Conspicuous fluctuation of blood pressure （≥20 mm Hg ）was observed in 21 patients during operation. Fifty-six cases were pathologically diagnosed as pheochromocytoma. All cases were followed up for 5 to 36 months. Postoperative blood pressure was normal in 36 cases within 2 months without any drug,while dosage of antihypertensive drugs was decreased in the remainders. There were no mortalities or recurrences of tumor. Conclusions As long as preoperative preparations are adequate and intraoperative manipulations are careful, retroperitoneoscopic adrenalectomy for pheochromocytoma could be a safe and minimally invasive procedure.