机器人辅助腹腔镜肾上腺恶性肿瘤切除术经验分享及文献复习

Robotic-assisted laparoscopic resection for adrenal malignancies:experience sharing and literature review

目的:初步总结机器人辅助腹腔镜切除肾上腺恶性肿瘤的经验,探讨其在肾上腺恶性肿瘤手术中的应用价值。方法:分析2015年2月~2016年8月间术前诊断为肾上腺恶性肿瘤9例患者的临床资料。9例患者均采用机器人辅助腹腔镜手术治疗。结果:所有手术均获成功,未中转开放。肿瘤位于左侧6例,右侧3例,肿瘤最大径3.1~15.5cm,平均7.1cm。肾上腺皮质癌4例、恶性嗜铬细胞瘤3例、肾上腺转移瘤2例。手术时间30~210min,平均85min。估计失血量50~1 100ml,平均270ml,2例需术中输血,均为肾上腺皮质癌。术后住院5~12d,平均8.5d。随访3~11个月,1例肾上腺皮质癌于术后6个月复诊时发现局部复发,其余患者随访期未见肿瘤复发。结论:机器人辅助腹腔镜切除肾上腺恶性肿瘤具有技术上的可行性,其视野和机械手臂灵活性的优势可能提高手术效果,但其肿瘤控制的远期疗效还需长期随访数据来证实。

Objective:To summarize the experience of robotic-assisted laparoscopic resection and to evaluate its value in the operation of adrenal malignancies.Methods:The clinical data of 9patients with preoperatively diagnosed adrenal malignancy and receiving robotic-assisted laparoscopic surgery between February 2015 and August2016were analyzed.Results:All the operations were successfully performed without conversion.Tumors were located on the left side in 6cases,and on the right side in 3cases.The average diameter of the tumors was 7.1cm(ranging from 3.1to 15.5cm).There were 4cases of adrenal cortical carcinoma,3cases of malignant pheochromocytoma,and 2cases of adrenal metastases.The average operative time was 85(range,30-210)min.Average estimated blood loss was 270(range,50-1 100)mL.Two patients with adrenal cortical carcinoma required intraoperative blood transfusion.Average postoperative hospital stay was 8.5(range,5-12)days.All patients were followed up for 3-11 months.One patient with adrenal cortical carcinoma got local recurrence after 6months,and the rest 8cases had no signs of tumor recurrence during the follow-up period.Conclusions:Robotic-assisted laparoscopic resection of adrenal malignancies is technically feasible,and the advantages of field of view and flexibility of robotic arms may improve the outcome of surgery.However,long-term follow-up data are needed to confirm the efficacy of tumor control.