肾上腺节细胞神经瘤腹腔镜手术治疗经验

Laparoscopic adrenalectomy in the treatment of adrenal ganglioneuroma

目的 总结肾上腺节细胞神经瘤的腹腔镜手术治疗经验,探讨手术方式的选择.方法 总结北京大学第一医院泌尿外科2002年2月至2010年8月收治的12例行腹腔镜切除的肾上腺节细胞神经瘤的临床病例资料,对手术相关数据进行分析.结果 12例肿瘤均无内分泌功能,肿瘤长径平均6.5 cm（1.5～16.8 cm）,其中腹膜后镜切除10例,平均长径6.0 cm,经腹腹腔镜切除2例,长径分别为7.5和10.7 cm.12例肿瘤中,3例肿瘤包绕肾蒂血管,1例肿瘤与肾粘连紧密.平均手术时间144 min,平均出血量194 ml,术后平均住院日5.4d.术后平均随访45个月,均无复发或转移.结论多数肾上腺节细胞神经瘤体积较大,如能选择适当的手术入路并注意保护肾血管,腹腔镜仍是一种安全、有效的手术方式.

Objective To evaluate the feasibility of laparoscopic adrenalectomy in the treatment of adrenal ganglioneuromas.Methods The clinical data of 12 cases of adrenal ganglioneuromas undergoing laparoscopic adrenalectomy between February 2002 and August 2010 were reviewed retrospectively.Results None of them had endocrine function.The average long diameter of ganglioneuromas was 6.5 cm （ range：1.5 - 16.8 cm）.Ten tumors were resected through retroperitoneal approach with an average long diameter of 6.0 cm and another two through transperitoneal approach with 7.5 and 10.7 cm in size respectively.Three tumors surrounded renal pedicle and one adhered to kidney. The average operative duration was 144 minutes,average blood loss 194 ml and average postoperative hospitalization stay 5.4 days.None had local recurrence and distant metastasis during a mean follow-up period of 45 months.Conclusion Laparoscopic adrenalectomy is both safe and feasible for adrenal ganglioneuromas if an appropriate approach is chosen and renal pedicle well-protected..