小儿后腹腔镜肾上腺切除术的可行性和安全性

Analysis of feasibility and safety of retroperitoneal laparoscopic adrenalectomy for children with adrenal tumors

目的 探讨后腹腔镜肾上腺切除术在小儿肾上腺肿瘤应用的可行性和安全性.方法 回顾选择性应用后腹腔镜肾上腺切除术治疗的15例小儿肾上腺肿瘤患者的临床资料,其中男8例,女7例,年龄2个月到13岁,中位年龄3岁;病变位于左侧7例,右侧8例;肿块直径1.4～13 cm,平均4.9 cm.结果 除1例瘤体巨大者中转开放手术外14例患儿手术完成,手术时间39～125 min,平均70 min.术中估计出血量30～120 ml,平均56 ml;1例嗜铬细胞瘤术中血压波动;术后并发腹膜后血肿和皮下气肿各1例,分别在1 d和5 d后自行吸收;术后住院6～7 d,平均6.3 d;病理结果肾上腺神经母细胞瘤7例,神经节瘤5例,神经节母细胞瘤、皮质腺瘤和嗜铬细胞瘤各1例.恶性肿瘤有适应证的行后续化疗.所有恶性肿瘤患儿随访6个月至13个月均存活无复发.结论 应用后腹腔镜肾上腺切除术治疗小儿肾上腺肿瘤安全可行,且创伤小、恢复快、外观美容,可作为良性、体积不大的肾上腺肿瘤的首选术式;体积较小、边界规则的恶性肿瘤也可适用.

Objective To investigate the feasibility and safety of retroperitoneal laparoscopic adrenalectomy for children with adrenal tumors. Methods Clinical data of 15 children （8 males and 7 males） with adrenal tumors who underwent laparoscopic adrenalectomy were retrospectively analyzed.The age ranged from 2 months to 13 years, with the median age of 3 years. There were 7 sinister and 8 dextral tumors with the average diameter at 4.9 cm ranging from 1.4 to 13 cm. Results Complete laparoscopic procedure was perform on all eases except 1 patient underwent conversion to open surgery due to extremely large size of the tumor. Mean operation time for laparoscopic procedure was 70 minutes ranging from 39 to 125 minutes. Mean blood loss during operation was 56 ml ranging from 30 to 120 ml. Intraoperative blood pressure fluctuation was noted in 1 patient with pheochromocytoma. One patient complicated with postoperative retroperitoneal hematoma which was absorbed 1 day later. The other one suffered subcutaneous emphysema which was absorbed 5 days later. Length of hospital stay was from 6 to 7 days with the average of 6. 3 days. Pathological diagnosis showed that 7 cases were adrenal neuroblastoma, 5 as ganglioma, 1 as ganglioblastoma, 1 as cortical adenoma, and the other 1 as pheochromocytoma. Patients with malignant tumors who were treated with chemotherapy were followed up for 6 to 13 months, all of whom were alive without recurrence. Conclusions Retroperitoneal laparoscopic adrenalectomy for children with adrenal tumors is a feasible, safe and minimally invasive procedure. Patients can have shorter length of stay and less surgical scar. The retroperitoneal laparoscopic adrenalectomy might become the primary alternative for patients with benign tumors or tumors with relatively smaller size. Some malignant adrenal tumors with small size or regular boundary can also be an indication for the laparoscopic procedure.