后腹腔镜与开放手术治疗肾上腺嗜铬细胞瘤的比较(附49例报告)

Posterior Laparoscopic Compared with Open Resection of Pheochromocytoma(Report of 49 Cases)

目的:比较后腹腔镜肾上腺嗜铬细胞瘤切除术(LRP)和开放性肾上腺嗜铬细胞瘤切除术(ORP)的优势。方法:2004年6月～2008年12月,我院共行肾上腺嗜铬细胞瘤手术49例,其中LRP组26例,ORP组23例,LRP组肿瘤直径2～7 cm,平均3.5 cm;ORP组肿瘤直径3～10 cm,平均5.5 cm。全部患者术前定性诊断明确,并行CT或MRI检查明确定位诊断。结果:25例腹腔镜手术获得成功,1例中转开放手术。LRP和ORP患者在手术时间、术中血压波动及术后住院时间方面差异无统计学意义(P>0.05);LRP组术后第1天引流量少于ORP组,两组之间的差异有统计学意义(P<0.05);LRP组术后可以尽早下床活动,两组之间的差异有统计学意义(P<0.05);23例ORP患者中有10例在术中或术后24 h内进行了输血,平均输血量为505 mI;而所有LRP患者均未进行输血。随访时间4～28个月,1例仍需服用降压药物。结论:腹腔镜肾上腺嗜铬细胞瘤切除术安全可行,疗效确切,可使患者尽早下床活动,并最大限度地减少输血情况发生;充分的术前准备和熟练的腹腔镜操作技术是手术安全的保证;肿瘤大小并非腹腔镜手术的禁忌证。

Objective：To compare posterior laparoscopic resection of pheochromocytoma（LRP） with open re section of pheochromocytoma（ORP）. Methods：From June 2004 to December 2008, 49 cases of pheochromocytoma were involved in this study,including 26 cases receiving LRP and 23 cases receiving ORP. The mean tumor size was 3.5 cm in diameter （range 2.0 to 7.0 cm） of LRP and 5.5 cm （range 3.0 to 10.0 cm） in ORP. Results：26 cases of LRP were technically successful in25 cases. There were no significant differences in operation time,intraoperative blood pressure fluctuation and postoperative hospital stay between LRP and ORP. However, there were significant differences in postoperatively first day＇s draining, postoperatively walking,intraoperative or postoperative transfusing between LRP and ORP. Conclusions：As compared with open operation, posterior laparoscopic resection of pheochromocytoma has the advantage of reducing bleeding, minimizing invasion, and accelerating recovery with shortened hospital stay. And the size of pheochromocytoma was not a contraindication of laparoscope.