3D腹腔镜手术治疗肾上腺嗜铬细胞瘤/副神经节瘤的临床研究

Clinical study of 3D laparoscopic surgery for adrenal pheochromocytoma / paraganglioma

目的 探讨3D腹腔镜下肾上腺嗜铬细胞瘤/副神经节瘤切除术的有效性和安全性.方法 回顾性分析2012年12月至2014年7月23例行3D腹腔镜下肾上腺嗜铬细胞瘤/副神经节瘤切除术患者的临床资料,男7例,女16例.年龄32 ～68岁,平均47岁.临床表现为持续性高血压11例,阵发性高血压8例,持续性高血压伴阵发性发作2例,无症状体检发现者2例.术前行内分泌、影像学及核医学等检查明确诊断,肿瘤直径3 ～ 14 cm,平均8 cm.术前服用α受体阻滞剂2～4周调整血压.全麻下行3D腹腔镜下肾上腺嗜铬细胞瘤/副神经节瘤切除术,其中经腹膜后途径19例,经腹腔途径4例.结果 本组23例手术均顺利完成.手术时间为60 ～120 min,平均（78±21） min.术中出血量为50 ～400ml,平均（54.8±36.3） ml.无术中邻近脏器损伤等并发症.住院时间为3～6d,平均（3.8±1.4）d.术后病理诊断为肾上腺嗜铬细胞瘤15例,副神经节瘤8例.术后随访3 ～18个月,23例均无复发和转移.结论 3D腹腔镜成像系统在术中空间定位及深度感觉上有明显优势,可缩短手术时间,提高手术安全性.

Objective To investigate the efficacy and safety of 3D-laparoscopic surgery in adrenalpheochromocytomas /paragangliomas.Methods From December 2012 to July 2014,23 cases of adrenal pheochromocytomas/paragangliomas were treated by 3D-laparoscopic surgery.Among them,7 cases were male and 16 cases were female,whose mean age are 47 （32-68） years old.Their clinical symptoms including sustained hypertension in 11 cases,intermittent hypertension in 8 cases,sustained hypertension with intermittent progression in 2 cases and asymptom in 2 cases.All tumors were diagnosed by endocrine examination,image test and nuclear medicine.Mean diameter of tumors are 8 cm,ranged from 3-14cm.In order to adjust the blood pressure,patients took α-receptor blocker for 2-4 weeks preoperatively.Under the general anesthesia,19 patients received the 3D-laparoscopic surgery via retroperitoneal approach and 4 cases received the procedure via peritoneal approach.Results All operations were completed successfully.There were no major intraoperative complications.Mean operating time was （78 ± 21） min and mean estimated blood loss was （54.8 ± 36.3） ml.Mean hospital stay after operation was （3.8 ± 1.4） days.The pathological diagnosis included pheochromocytomas in 15 cases and paragangliomas in 8 cases.During the 3 to 18 months following up,no recurrence or metastasis was found in this study.Conclusions 3D-laparoscopic surgery has obvious advantage in spatial location and the sense of depth for adrenal pheochromocytomas /paragangliomas,which shortens the operation time and increase the safety obviously.