后腹腔镜下肾上腺嗜铬细胞瘤切除(附29例报告)

Retroperitoneal laparoscopic adrenalectomy for pheochromocytoma (a report of 29 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29例。肿瘤位于左侧17例、右侧12例。肿瘤直径3.5～8.0cm,平均(4.6±2.0)cm。临床表现为高血压者25例;无症状经体检发现者4例。29例均行内分泌常规检查和影像学检查。术前常规扩容、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29例手术均成功。手术时间65～220min,平均(58±22)min,术中估计出血量20～400mL,平均(82±36)mL,术后住院时间4～8d,平均(5±1)d。术中术后未发生重大并发症。术后病理报告均为嗜铬细胞瘤。随访2～36个月,27例患者术后1个月内血压恢复正常,2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 retroperitoneal laparoscopic adrenalectomy for the treatment of pheochromocytoma.. [Methods] Retroperitoneal laparoseopic adrenalectomy was performed on 29 patients with pheochromocytoma. Seventeen tumors were on the left side and 12 on the right. The mean tumor size was （4.6±2.0） cm in diameter （range： 3.5 - 8.0 era）. Twenty-five patients mainly presented hypertension, and 4 cases had no hypertension or other symptoms. 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] All the operations were completed successfully. Mean operating time was （58±22） minutes （range： 65-220 min ）. Mean estimated blood loss was （82±36） mL （range 20-400 mL）. Mean hospital stay after operation was （5±1） days （range 4-8 days）. There were no major intraoperative complications. All the 29 cases were pathologically diagnosed as pheochromocytoma. They were followed up for 2-36 months. Postoperative blood pressure was normal in 27 cases within 1 month 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, retroperitoneal laparoscopic adrenalectomy for pheochromocytoma could be a safe and minimally invasive procedure.