局限性肾上腺神经母细胞瘤腹腔镜手术疗效评估

Evaluations of laparoscopic adrenalectomy for local adrenal neuroblastoma

目 的分析腹腔镜手术治疗局限性肾上腺神经母细胞瘤的手术效果及远期预后。方法我们将肿瘤原发灶局限于肾上腺，INSS分期为Ⅰ～Ⅱ期及IVS期的神经母细胞瘤确定为局限性肾上腺神经母细胞瘤。回顾性分析2005年6月至2013年6月行腹腔镜手术治疗的局限性肾上腺神经母细胞瘤15例的临床资料，分析病例的肿瘤大小、手术时间、出血量、长期预后及肿瘤复发等数据。结果本组15例中，男11例，女4例；年龄2～158个月，平均39．47个月。左侧肾上腺病变2例，右侧13例。根据INSS分期系统，Ⅰ期12例，Ⅱ期1例，Ⅳs期2例。根据Shimada分类，神经母细胞瘤8例，节细胞神经母细胞瘤7例。肿瘤大小1．98～6．00cm，平均（3．92±1．31）cm。手术时间90～240min，平均（138．13±45．63）min。手术出血量10-50ml，平均（13．75±11．32）ml，仅1例患儿输血75ml。2例（12．5%）患儿手术中分别因肿瘤包绕肾血管无法分离和游离肿瘤时膈肌破损，而中转开腹。所有手术均完整切除肿瘤。所有患儿均获得随访，随访时间2～63个月，平均26．93个月。腹腔镜手术均无复发病例，腹腔镜手术5年总生存率为100％。结论局限性肾上腺神经母细胞瘤进行腹腔镜手术是安全、可行的。对于肿瘤大小〈6cm、无重要血管包绕的肾上腺神经母细胞瘤可首选腹腔镜手术。

Objective To explore the long-term oncologieal outcomes in children undergoing laparoscopy for local adrenal neuroblastoma. Methods A retrospective review was conducted for 43 children with local adrenal neuroblastoma hospitalized at our hospital between July 2005 and July 2013. They fulfilled the inclusion criteria for adrenal neuroblastoma and underwent resection. Results Laparoscopic adrenalectomy was performed. There were 11 males and 4 females with a mean age of 39. 47 （2-158） months. There were left （n = 2） and right （n = 13） adrenal lesions. According to the international neuroblastoma staging system, there were stage I （n = 12）, stage II （n = 1） and stage IV （n = 2）. Two patients were converted into open surgery because of adhesions to renal vessels and diaphragmatic rupture. The tumor size, operative duration and blood loss volume were （3.92 ± 1.31） cm, （138. 13 ± 45.63）min and （13.75 ± 11.32）ml respectively. The mean follow-up period was 26. 93 （2-63） months. There was no recurrence for laparoscopic surgery. The overall 5-year survival rate of laparoscopy was 100%. Conclusions Laparoscopic resection of adrenal neuroblastoma is feasible and it may be performed with equivalent recurrence and mortality rates to open resection. For tumor size 〈6 cm without vascular encasement, laparoscopic surgery of adrenal neuroblastoma is preferred.