机器人辅助腹腔镜技术治疗儿童肾上腺嗜铬细胞瘤一例并文献复习

Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma:one case report with a literature review

目的探讨机器人辅助腹腔镜下肾上腺部分切除术治疗儿童嗜铬细胞瘤的疗效及安全性。方法以上海交通大学附属儿童医院2020年7月收治的一例肾上腺嗜铬细胞瘤患者作为研究对象,回顾分析其临床资料,结合文献复习进行讨论和分析。结果该患者为8岁男童,有高血压,并伴发相关临床症状,影像学检查提示右侧肾上腺区椭圆形肿物,边界尚清,周围脏器未见明显肿瘤浸润。24 h尿VMA、血液及24 h尿中儿茶酚胺代谢产物明显增高,提示嗜铬细胞瘤,予降压扩容2周后行机器人辅助腹腔镜下肾上腺部分切除术。术中见肿瘤大小约4 cm×3 cm×3 cm,质韧,表面血管怒张,瘤体内上方可见正常肾上腺组织,精细操作下保留部分正常肾上腺组织。腹腔内手术时间为105 min,术中出血约400 mL,予输血治疗。术后病理检查提示嗜铬细胞瘤,包膜完整。术后患者恢复良好,住院6 d,复查尿VMA、血液及24 h尿中儿茶酚胺代谢产物基本正常。术后6个月,门诊复查超声未见异常,血压恢复正常,无其他术后并发症。结论对于儿童肾上腺嗜铬细胞瘤,传统腹腔镜手术难度较大,采用机器人辅助腹腔镜技术能安全高效地完成手术,具有出血少和术后住院时间短等优点。

Objective To explore the efficacy and safety of robot-assisted laparoscopic partial adrenalectomy for pheochromocytoma in children.Methods One 8-year-old boy of adrenal pheochromocytoma was admitted in July 2020.Clinical data and surgical findings were retrospectively analyzed with a literature review.Results Hypertension was associated with other clinical symptoms.Imaging examination revealed an elliptic mass in right adrenal area.With a distinct boundary,there was no overt tumor invasion in the surrounding organs.And 24 h urinary vanillylmandelic acid(VMA),blood and 24 h urinary catecholamine metabolites spiked markedly.It hinted at pheochromocytoma.Robot-assisted laparoscopic partial adrenalectomy was performed after hypotension and volume expansion for 2 weeks.Tumor size was around 4×3×3 cm.Normal adrenal structure could be visualized and part of it was preserved during operation.The intra-abdominal procedure lasted 105 min and bleeding was around 400 mL.Blood transfusion was provided.Pathological examination confirmed pheochromocytoma with an intact capsule.The child recovered well after surgery and was hospitalized for 6 days.Reexamination of urinary VMA,blood and catecholamine metabolites in urine for 24 h remained basically normal.During a follow-up period of 6 months,both ultrasound and blood pressure normalized without other postoperative complications.Conclusion For adrenal pheochromocytoma in children,traditional laparoscopy is problematic.However,robotic-assisted laparoscopic partial adrenalectomy may be safely and selectively performed with minimal bleeding and shorter postoperative hospital stay.