后腹腔镜治疗12例肾上腺嗜铬细胞瘤回顾分析

Retroperitoneal laparoscopic adrenalectomy for the treatment of adrenal phenochromocytoma:Report of 12 cases

目的评估后腹腔镜治疗肾上腺嗜铬细胞瘤的实用性。方法对12例肾上腺嗜铬细胞瘤患者行后腹腔镜手术治疗。平均直径3.6cm(2.5～6.2cm),左侧5例,右侧7例。结果 12例手术均获成功、无手术并发症、术后临床症状和体征消失。平均手术时间为62±16min,平均出血量为58±13ml;瘤体直径为4.4±2.1cm。术后病理均证实为嗜铬细胞瘤。平均随访1.2年,除2例血压仍高外,其余患者临床症状和体征消失,生化检查24h尿儿茶酚胺(肾上腺素、去甲肾上腺素、多巴胺)及香草扁桃酸(VMA)均恢复正常。结论后腹腔镜治疗肾上腺嗜铬细胞瘤不失为一种可靠、安全的手术方法。术前充分的扩容和降压、术中熟练的操作及与麻醉师的良好配合是保证肾上腺嗜铬细胞瘤手术顺利完成的必要条件。

Objective To assess the fesibility of retroperitoneal laparoscopic adrenalectomy in the treatment of adrenal phenochromocytoma.Methods From May 2003 to April 2009,12 cases of adrenal pheochromocytoma received retroperitoneal laparoscopic andrenalectomy.The average diameter was 3.6 cm（range 2.5 to 6.2 cm）,the lesion located in the left side in five cases and in the right side in seven cases.Results Twelve cases underwent successful surgery.Mean operative time was 62±16 min,the blood loss was 58±13 ml;tumor diameter were 4.4±2.1 cm.Pathological examination confirmed as pheochromocytoma.The average follow-up was 1.2 years,no surgery related complications occurred,the clinic symptoms and signs were disappeared except two of them with high blood pressure existed.Urine biochemical tests indicated that 24 h urinary catecholamines（adrenalin,noradrenalin,dopamine） and vanillylmandelic acid（VMA） were normal.Conclusion Retroperitoneal laparoscopic adrenalectomy for the treatment of phenochromocytoma is safe and feasible in selected populations,preoperative appropriate hydration,blood pressure control,adepted skill during the surgery and coordination between anesthetist are necessary for the operation.