经腹腹腔镜下治疗腹膜后Castleman病

Transperitoneal laparoscopic operation for Castleman′s disease

目的探讨腹膜后肾上腺区Castleman病的临床特点、诊断及腹腔镜治疗方法。方法回顾性分析我院2010-2011年收治的3例腹膜后肾上腺区巨大Castleman肿瘤患者临床资料,行彩超、SCT平扫及增强等影像学检查,术前诊断为:腹膜后巨大淋巴增生症2例,静止性嗜铬细胞瘤1例。均行经服腹腔镜下肾上腺区肿瘤切除术。结果 3例腹腔镜手术均顺利完成,1例术中出现血压波动,最高至180/115 mm Hg。手术时间平均1.5 h;术中出血量平均80 ml;切除肿瘤大小5.0 cm×5.5 cm×4.5 cm^7.0 cm×8.0 cm×4 cm。术后无明显并发症,平均7 d出院。术后病理均证实为Castleman病。术后随访1~2.5年(平均1.5年),患者临床症状消失,复查彩超或SCT,未见肿瘤复发或转移。结论腹膜后Castleman病罕见,其中以局灶型多见。手术是其治疗首选。腹腔镜下切除途径视野清晰、利于操作、出血较少、恢复快,是治疗腹膜后复杂性Castleman病的一种理想方法。

Objective To investigate the clinical features, diagnosis, and treatment of adrenal area tumor associated with Castleman＇s disease. Methods The clinical data of 3 cases Castleman＇s disease （2 males, 1 female, mean age 45 years）were analyzes. The diagnosis of Castleman＇s disease was set up by B- ulreasound, CT or MRI exam. Preoperative diagnoses were Castleman＇s disease in 2 cases,in lcases.All cases underwent transpertioneal laparoscopic operation of adrenal tumor. Results All operations were completed successfully. The average operation time was 1.5 h, the average blood loss was 80 ml, and the average hospital stay was one week. The tumor size was form 5.0 cm× 5.5 cm× 4.5 cm to 7.0 cm× 8.0 cm × 4 cm, and no surgical complications happened. The pathological reports showed Castlemau＇s disease.All cases were followed up for I to 2.5 years, and no recurrence. Conclusion Castleman＇s disease is a rare disease and the tumor may occur anywhere in lymphoid tissue,especially in mediastinal cavity, neck, and axilla region, but rarely seen in adrenal area.Abdominal laparoscopic route a clear field of vision, good operation, less bleeding, faster recovery. It＇s a treatment ideal of the retroperitoneal Castleman＇s disease.