CT三维重建辅助下机器人肾上腺切除术治疗肾上腺巨大肿瘤的可行性和安全性

Feasibility and safety of robotic-assisted laparoscopic adrenalectomy with the assistance of threedimensional reconstruction of computed tomography image to treat huge adrenal tumors

目的探讨基于CT三维重建技术辅助的机器人肾上腺切除术治疗肾上腺巨大肿瘤的有效性和安全性。方法回顾性分析同济医院2015年1月至2021年1月收治的29例肾上腺肿瘤患者的病例资料,男13例,女16例。中位年龄43(25,57)岁。中位体质量指数25.2(20.8,29.8)kg/m^(2)。肿瘤位于左侧18例,右侧11例。中位肿瘤直径12.1(10.3,16.2)cm。患者术前均行CT增强扫描,并根据检查数据重建三维图像。三维图像可分别或同时显示器官、血管和病灶,术者可直观、全面了解肿瘤与周围脏器、大血管的关系,并做出充分的风险评估和制订手术策略。本组29例均全麻下行机器人辅助腹腔镜肾上腺切除术。结果本组29例手术均顺利完成,无大量出血、二次手术、死亡等严重并发症。中位手术时间131(80,245)min,中位术中出血量330(50,2200)ml,9例接受输血。术后病理诊断为嗜铬细胞瘤11例(37.9%),腺癌10例(34.5%),畸胎瘤2例(6.9%),皮质癌6例(20.7%)。术后中位随访30个月,3例失访;2例皮质癌患者术后出现复发或转移,分别于术后16个月和23个月死亡;余24例均存活。结论机器人辅助腹腔镜肾上腺肿瘤切除术可作为治疗肾上腺巨大肿瘤安全、有效的术式。CT三维重建能有效辅助机器人肾上腺切除术的术前规划,减少潜在的并发症。

Objective Efficacy and safety of robot-assisted laparoscopic adrenalectomy as a treatment for large adrenal tumors.Three-dimensional(3D)reconstruction can effectively assist in preoperative planning of robotic adrenalectomy and reduce potential complications.Methods We retrospectively reviewed the relevant information of patients who had a preoperative 3D reconstruction and underwent RA for adrenal masses larger than 10 cm.Thirteen male patients and sixteen female patients were included.The median(range)age was 43(25,57)years old and the median tumor diameter was 12.1(10.3,16.2)cm.The patients underwent preoperative CT enhancement scanning,and three-dimensional images were reconstructed based on the examination data.Robot-assisted laparoscopic adrenalectomy was performed under general anesthesia in 29 cases in this cohort.Results All surgeries were completed successfully without major complications such as massive bleeding,secondary surgery,or even patient death.The median operative time was 131(80,245)min,and the median intraoperative bleeding was 330(50,2200 ml)ml.9 patients received blood transfusions.There were 11 cases of pheochromocytoma(37.9%),10 cases of adenocarcinoma(34.5%)as well as 2 cases of teratoma(6.9%)and 6 cases of cortical carcinoma(20.7%).The patients were followed up for a median of 30 months after surgery.Except for 3 cases lost to follow-up and 2 patients with cortical cancer who developed recurrence or metastasis after surgery and died at 16 and 23 months afer surgery,respectively,the remaining 24 cases have survived to date.Conclusions RA is a safe and effective treatment for huge adrenal tumors.The 3D reconstruction could help the preoperative planning of RA and reduce potential complications.