后腹腔镜治疗肾上腺嗜铬细胞瘤16例

Retroperitoneoscopic Adrenalectomy for Pheochromocytoma:Report of 16 Cases

目的评价后腹腔镜肾上腺切除治疗嗜铬细胞瘤的临床价值。方法对我科2000年1月～2006年10月16例后腹腔镜治疗肾上腺嗜铬细胞瘤的临床资料进行回顾性分析。左侧10例,右侧6例,瘤体直径2.5～4.6cm,平均3.1cm。结果术前准备时间6～28d,平均11d。除1例因肿瘤周围粘连严重和出血中转开放外,其余15例均成功切除肿瘤,手术时间平均110min(90～170min),手术出血量平均135ml(80～650ml)。3例嗜铬细胞瘤切除后血压正常,术后即刻未用去甲肾上腺素溶液,其中2例分别在术后4和6h收缩压由135mmHg降至80mmHg,1例56h后收缩压突然由140mmHg降至85mmHg,立即应用去甲肾上腺素溶液维持血压正常。术后病理诊断15例为良性肾上腺嗜铬细胞瘤,1例开放者为低度恶性嗜铬细胞瘤,局部包膜浸润。术后平均住院12d(9～20d)。术后随访3～24个月,平均13个月,除1例需口服降压药外,其余血压均自然恢复正常,24h尿去甲肾上腺素、肾上腺素及儿茶酚胺含量均正常。结论后腹腔镜肾上腺切除是治疗嗜铬细胞瘤的有效方法,具有创伤小、并发症少及恢复快等优点。术前准备和术后处理在治疗嗜铬细胞瘤的过程中具有较重要的价值。

Objective To evaluate the efficacy of retroperitoneoscopic adrenalectomy for pheochromocytoma. Methods From January 2000 to October 2006, a total of 16 patients （aged from 32 to 65 with a mean of 42 years） with pheochromoeytoma received retroperitoneoscopic adrenalectomy in our hospital. Among the cases, 6 had the tumor on the right side, and 10 on the left. The size of the tumors ranged from 2.5 to 4.6 cm in diameter （ mean, 3.1 era）. Results The mean preoperative preparation time in this series was 11 days （range, 6 to 28）. The retroperitoneoscopic adrenalectomy was completed in all but one of the patients, who were converted to open surgery because of extensive adhesion of the tumor to surrounding tissues and massive bleeding. The mean operation time was 110 minutes （90 to 170） , and the mean blood loss was 135 ml （80 to 650）. Three cases, who had normal blood pressure and thus received no noradrenalin immediately after the surgery, was given noradrenalin emergently 4, 6, or 56 hours later owing to asudden drop of systolic pressure （from 135 mm Hg to 80 mm Hg in 2, and from 140 mm Hg to 85 mm Hg in 1）. Postoperative examination showed benign pheochromocytoma in 15 of the cases, and low-grade malignant pheoehromoeytoma with local invasion of the capsule in the patient who was converted to open surgery. The mean postoperative hospital stay was 12 days （9 to 20）. The patients were followed up for 3 to 24 months （mean, 13） , during which only one received antihypertensive drugs; the others restored normal blood pressure spontaneously. No patient had abnormal levels of 24-hour urine noradrenalin, adrenalin, and eateeholamine. Conclusions Retroperitoneoseopie surgery is an effective and minimally invasive treatment for patients with adrenal pheochromocytoma. The patients have a few complications and recover quickly after the operation. Preoperative preparation and postoperative treatment are important for the outcomes of the disease.