嗜铬细胞瘤182例手术治疗分析

Surgical treatment of 182 cases with pheochromocytoma

目的提高嗜铬细胞瘤的治疗水平。方法回顾性分析2003年9月至2011年6月本院手术治疗182例嗜铬细胞瘤患者的临床资料,并进行各项指标的统计分析。结果所有患者均成功手术切除肿瘤。嗜铬细胞瘤腹腔镜组(LA)15例无中转开放手术,切除肿瘤直径3.5～7cm,平均(5.2±1.58)cm;出血量20～700mL,平均(48±39)mL;手术时间70～180min平均(122.0±43.3)min;术后下床活动时间1～3d,平均(2.2±0.7)d;住院时间5～8d;平均(6.5±1.4)d。嗜铬细胞瘤开放手术组143例,切除肿瘤直径4.5～18.5cm,平均(6.2±3.1)cm;出血量60～2 200mL,平均(220±118)cm;手术时间80～240min,平均(122.0±43.3)min;术后下床活动时间2～5d,平均(4.1±0.8)d;住院时间7～15d,平均(9.3±1.7)d。副神经节瘤组24例,肿瘤直径5.0～9.5cm,恶性肿瘤15例。结论对有较丰富腹腔镜手术经验的术者,后腹腔镜肾上腺嗜铬细胞瘤手术手术时间短、出血量少、对患者的刨伤小,是治疗肾上腺嗜铬细胞瘤安全、有效的方法;推荐开放手术治疗副神经节瘤。

Objective To evaluate the surgical treatment of pheochromocytoma.Methods We retrospectively reviewed and analyzed the medical records of 182 patients with pheochromocytoma who were treated during Sept.2003 to June 2011.Results All operations were successful.For the 15 patients treated with laparoscope,the maximum diameter of tumor was 3.5~7 cm,averaging（5.2±1.58） cm.The bleeding volume was 20~700 mL,averaging（48±39）mL.The operation time was 70~180 min,averaging（91.0±52.1）min.The patients were able to move off bed 1~3 d after operation,averaging（2.2±0.7） d.The postoperative hospital stay was 5~8d,averaging（6.5±1.4） d.For the 143 patients treated with open surgery,the maximum diameter of tumor was 4.5~18.5 cm,averaging（6.2±3.1） cm.The bleeding volume was 60~2 200 mL,averaging（220±118）mL.The operation time was 80~240 min,averaging（122.0±43.3） min.Patients were able to move off bed 2~5 d after operation,averaging（4.1±0.8）d.postoperative hospital stay was 7~15 d,averaging（9.3±1.7）d.For the 24 patients with paraganglioma,the maximum diameter of tumor was 5.0~9.5 cm,averaging（6.8±1.4） cm.15 cases were malignant.Conclusions Retroperitoneoscopic adrenalectomy has advantages of shorter operation time,less blood loss and minimal invasion,which is safe and effective to treat pheochromocytoma.Open surgery is recommended for the treatment of paraganglioma.