后腹腔镜治疗肾上腺嗜铬细胞瘤安全性及实用性探析.docVIP

后腹腔镜治疗肾上腺嗜铬细胞瘤安全性及实用性探析 　 作者：杨志尚，何辉，赵军，吴大鹏 【关键词】 腹腔镜；嗜铬细胞瘤；肾上腺肿瘤 　　Safety and feasibility of retroperitoneoscopic surgery for adrenal pheochromocytoma 　　ABSTRACT: Objective To evaluate the safety and feasibility of retroperitoneoscopic surgery for adrenal pheochromocytoma. Methods 11 patients with pheochromocytoma and 32 patients with benign adrenal adenoma underwent retroperitoneoscopic surgery. The operation time, blood loss, complication, tumor size, and postoperative rehabilitation were analyzed retrospectively. Results Retroperitoneoscopic surgery for adrenal pheochromocytoma and benign adenoma was completed smoothly in all patients. There was a significant difference in operation time and blood loss between pheochromocytoma and adenoma groups. No difference was found in postoperative complication and rehabilitation. After surgery, clinical symptoms and signs disappeared gradually. Hormone measurement results were in normal values. Conclusion Based upon the efficacious preoperative medication, tumor localization, improvement of patient’s general condition, and intraoperative cooperation between the surgeen and anesthetist, retroperitoneoscopic surgery for treatment of adrenal pheochromocytoma especially for small tumor is safe, feasible, and effective. 　　KEY WORDS: laparoscopy; pheochromocytoma; adrenal adenoma 　　摘要：目的 评估后腹腔镜治疗肾上腺嗜铬细胞瘤的安全性和实用性。方法 回顾性分析后腹腔镜治疗肾上腺嗜铬细胞瘤和其他肾上腺良性肿瘤的临床资料，对比两组之间的异同点。结果 11例肾上腺嗜铬细胞瘤和32例其他肾上腺良性肿瘤均经后腹腔镜顺利完成肿瘤切除。除手术时间和失血量两组之间有显著性差异外，术后并发症、止痛剂用量及术后恢复时间均无显著性差异。术后临床症状和体征逐渐消失，激素水平恢复正常。结论 术前准确的定位诊断，充分的扩容、降压和改善全身情况是保证肾上腺嗜铬细胞瘤手术顺利完成的必要条件。在与麻醉师的密切配合下，后腹腔镜肾上腺嗜铬细胞瘤切除是安全有效的方法，特别适合于较小的肾上腺嗜铬细胞瘤。 　　关键词：腹腔镜；嗜铬细胞瘤；肾上腺肿瘤 　　腹腔镜手术治疗肾上腺肿瘤已在国内外广泛应用，随着设备的完善和操作技能的提高，有报道认为腹腔镜肾上腺切除是治疗肾上腺肿瘤的金标准[1]。但肾上腺嗜铬细胞瘤切除术中易引起血压剧烈波动，以及嗜铬细胞瘤体积较大血供丰富，均增加了手术的难度和风险。为了手术的顺利完成，应充分认识肾上腺嗜铬细胞瘤与其他肾上腺良性肿瘤在生物学特性、组织结构、和腹腔镜操作上的差异。我科从2001年11月到2006年12月行后腹腔镜治疗肾上腺嗜铬细胞瘤11例和其他肾上腺良性肿瘤32例， 现报告如下。 　　1 资料与方法 　　1.1 临床资料 本组43例，男性16例，女28例，年龄18-65岁，其中肾上腺嗜铬细胞瘤11例，男4例，女7例，年龄28-45岁，其他肾上腺良性肿瘤32例，男8例，女24例，年龄18