腹腔镜下切除无症状、生化正常的肾上腺嗜铬细胞瘤12例报告

Laparoscopic resection of asymptomatic and biochemically silent adrenal pheochromocytoma:a report of 12 cases

目的:探讨无症状、生化检查正常的肾上腺嗜铬细胞瘤的诊治原则。方法:回顾分析12例无症状、生化检查正常的肾上腺嗜铬细胞瘤患者的临床资料,术前口服酚苄明1～2周,充分扩容,行腹腔镜肾上腺肿瘤切除术,其中经腰2例,经腹10例。结果:12例患者术中挤压肿瘤时血压均波动明显,手术一期完成,未发生大出血、心脑血管意外等严重并发症,无一例中转开放手术。术后病理均诊断为肾上腺嗜铬细胞瘤。随访6～36个月,血压正常,无复发。结论:无症状、生化检查正常的肾上腺肿瘤临床多见,术前按嗜铬细胞瘤进行准备,充分扩容后行腹腔镜手术是安全、有效的。

Objective：To evaluate the diagnosis and treatment principles of asymptomatic and biochemically silent adrenal pheochromocytoma （ ABSAP）. Methods：The clinical data of 12 patients with ABSAP were analyzed retrospectively. All were adequately given volume expansion preoperatively using oral phenoxybenzamine for one to two weeks. Then laparoscopic adrenal pheochromocytoma resections were performed. Among all 12 cases, 10 received the surgery using transperitoneal approach, the other 2 cases using retroperitoneal laparoscopy. Results：All 12 cases showed significant fluctuation of blood pressure when they experienced tumor crushes intraoperatively. All cases were one-stage operation without second incision. No severe hemorrhage, cardiovascular or cerebrovascular accident, and no conversion to open operation occurred. All pathological diagnoses were adrenal pheochromocytoma. After six months to three years＇ follow-up, all patients＇ blood pressures were normal. No pheochromocytoma recurrence was found. Conclusions：Adrenal pheochoromocytomas are often asymptomatic and biochemically silent. All asymptomatic adrenal gland neoplasms should he well prepared preoperatively according to the preparation for pheoehromocytoma. Laparoscopic resection of ABSAP is safe and effective after adequate expanding the blood volume.