腹膜后腹腔镜手术治疗肾上腺嗜铬细胞瘤

Retroperitoneal laparoscopic surgery for adrenal pheochromocytoma.

目的探讨经腹膜后入路施行腹腔镜肾上腺嗜铬细胞瘤切除术的疗效。方法行腹膜后腹腔镜肾上腺嗜铬细胞瘤切除术32例,术前经尿VMA、MRI及^(131)I-MIBG确诊为肾上腺嗜铬细胞瘤26例,拟诊嗜铬细胞瘤6例。术前均用苯苄胺等药物准备2～4周。手术采用气管内麻醉,取患侧向上的全侧卧位,经腹膜后入路,"手指分离法"建立腹膜后工作空间,显露肿瘤,用超声刀分离肿瘤周围组织,较大的血管及肾上腺中央静脉用钛夹双重钳夹后剪断,将瘤体置入标本袋内取出。结果32例均在腹膜后腹腔镜下顺利切除肿瘤。手术时间45～180 min,平均(91.2±22.5)min。出血量20～160 ml,平均(64.3±24.1)ml。29例(90.6%)在分离瘤体时血压波动<40 mm Hg。瘤体直径28～53 mm,平均(39.5±7.7)mm。术后血压稳定,疼痛较轻,术后4～9 d出院。病理检查证实均为肾上腺嗜铬细胞瘤。结论腹膜后腹腔镜肾上腺嗜铬细胞瘤切除术具有操作精细准确,不需过多地推动和挤压肿瘤,出血少,创伤小,恢复快等优点。

Objective To evaluate the retroperitoneal laparoscopic surgery for adrenal pheochromocytoma. Methods 32 cases underwent retroperitoneal laparoscopic adrenalectomy for adrenal pheochromocytoma. The pheochromocytoma was confirmed in 26 patients by the urinary catecholamine assay （ VMA ） , magnetic resonance imaging （MRI） and metaiodobenzylguanidine scintigraphy （^131I-MIBG）. And the other six patients were suspected. All patients were given phenoxybenzamine for two to four weeks preoperatively. The operations were performed under general anesthesia via retroperitoneal approach. The retroperitoneal space was established by finger dilation. Gerota＇s fascia was exposed and opened to expose the adrenal tumor. The peritumor tissue was separated with harmonic scalpel. The large vessel and the adrenal central vein were clamped with clip and the adrenal artery and adrenal divided with harmonic scalpel. The gland or the tumor was put in a plastic bag and removed. Results Laparoscopic procedures were completed in all the cases. The mean （range） operating time was 91.2 ±22.5 minutes （45-180 minutes）. The mean （range） blood loss was 64.3 ±24.1 ml （20-160 ml）. Blood pressure fluctuated less than 40 mm Hg in 90.6% （29/ 32 ） of the cases during separating the mass. The diameters of the specimens ranged from 28 mm to 53 mm （ mean, 39.5 mm）. There was no intraoperative or postoperative complication. The patients were all uneventful and discharged four to nine days postoperatively. The pathological diagnosis of the specimen was adrenal pheochromocytoma in cases. Conclusion Retroperitoneal laparoscopic surgery for adrenal pheochromocytoma is minimally invasive, which makes meticulous manipulation possible and reduces bleeding.