后腹腔镜下单侧肾上腺嗜铬细胞瘤切除术56例临床疗效分析

Retroperitoneal laparoscopic resection of unilateral adrenal pheochromocytoma in 56 cases

目的观察经后腹腔入路腹腔镜下单侧肾上腺嗜铬细胞瘤切除术的临床疗效。方法收集2016年12月至2019年5月在河南大学河南省人民医院行经后腹入路腹腔镜下单侧肾上腺PHEO切除术,且病理证实为PHEO的56例患者的住院资料,包括手术时间、术中最高收缩压、术中出血量、术后引流管拔除时间、出院时间及手术并发症等资料,对其进行系统性回顾分析。结果51例完成后腹腔镜下瘤体切除,3例中转开腹切除,2例终止手术;手术时间60~325min,出血量25~375 mL,最高收缩压范围140~226mm Hg,术后进食水时间1~3d,拔管时间2~6d,出院时间4~14d,均未见严重并发症。随访6至12个月,52例入院症状消失,血压水平控制稳定;3例血压仍然较高,需继续服药治疗;1例肿瘤复发,开腹行二次手术治疗;均未见肿瘤复发。结论经后腹入路腹腔镜下单侧肾上腺PHEO切除术具有出血量少、拔管及出院时间短和并发症少等优点,可作为治疗单侧PHEO治疗的首选术式。

Objective To observe the clinical effect of laparoscopic resection of unilateral adrenal pheochromocytoma via retroperitoneal approach.Methods The hospitalization data of 56 patients who underwent laparoscopic unilateral adrenalectomy underwent laparoscopic retroperitoneal approach in our hospital from December 2016 to May 2019,and pathologically confirmed PHEO were collected,including the operation time and the highest contraction during the operation.Data such as pressure,intraoperative blood loss,postoperative drainage tube removal time,discharge time,and surgical complications were systematically reviewed and analyzed.Results After laparoscopic tumor removal in 51 cases,3 cases were converted to open resection and 2 cases terminated surgery.The operation time was 60~325 min,the bleeding volume was 25~375 mL,the maximum systolic blood pressure range was 140~226 mm Hg,and the postoperative feeding time was 1~3 d,extubation time 2~6 d,discharge time 4~14 d,no serious complications were found.During a follow-up of 6 to 12 months,52 patients had no admission symptoms and the blood pressure level was stable.Three patients had high blood pressure and continued to take medication.One patient had a tumor recurrence and had open surgery for another operation.No tumor recurrence was found.Conclusion Laparoscopic unilateral adrenalectomy with retroperitoneal approach has the advantages of less bleeding,short extubation and discharge time,and fewer complications.It can be used as the first choice for unilateral PHEO treatment.