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Laparoscopic Surgery for Adrenal Pheochromocytoma and Paraganglioma:Report of 211 Cases
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摘要:目的 探讨腹腔镜肾上腺嗜铬细胞瘤及副神经节瘤切除术的有效性和安全性。方法 分析本院2003年以来成功实施的腹腔镜肾上腺嗜铬细胞瘤及副神经节瘤切除术211例, 肿瘤直径2~16cm, 术前行内分泌、影像学及核医学等检查, 并服用2~4周α受体拮抗剂。结果 211例患者手术时间为(97±29) min (60~170min), 术中出血量(84.6±56.3) ml (15~250ml), 住院时间(4.9±1.6) d (3~7d); 术后病理结果证实, 肾上腺嗜铬细胞瘤170例、副神经节瘤41例。随访3个月至7年, 12例因复发、转移而被诊断为恶性肾上腺嗜铬细胞瘤(副神经节瘤)。结论 肾上腺嗜铬细胞瘤及副神经节瘤一经确诊, 应该在充分药物准备的基础上, 实施手术切除。与传统开放手术相比, 腹腔镜手术切除肿瘤对血流动力学干扰小, 具有微创、切除彻底、手术时间短、出血少、术后恢复快等优点。Abstract:Objective To explore the effectiveness and safety of laparoscopic surgery in treating adrenal pheochromocytomas and paragangliomas.Methods The clinical data of 211 patients with pathologically confirmed adrenal pheochromocytomas (n=170) or paragangliomas (n=41) (ranges 2-16 cm in diameter) treated with laparoscopic surgery in our center from 2003 to 2010 were retrospectively reviewed. Endocrine examinations, ultrasound, CT, MRI, and 131I MIBG were performed before surgery. Patients also received α-receptor blocker for 2-4 weeks preoperatively.Results All the operations were successfully performed, with a mean operating time of (97±29) min (60-170 min) and a mean estimated blood loss of (84.6±56.3) ml (15-250 ml). The mean hospital stay after operation was (4.9±1.6) days (3-7 days). No major intraoperative complication was noted. Patients were followed up for 3-84 months, and 12 experienced recurrences, which were further diagnosed as malignant tumors.Conclusions Surgery is required once a diagnosis of adrenal pheochromocytoma or paraganglioma is confirmed. Laparoscopic surgery is a safe and minimally invasive procedure for adrenal pheochromocytomas and paragangliomas.
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Keywords:
- laparoscopy /
- adrenal tumo /
- pheochromocytoma /
- paraganglioma
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北京协和医院血管外科刘昌伟教授对2002年4月至2008年4月收治的10例贝赫切特病(白塞病)合并主动脉假性动脉瘤患者的预后情况进行研究, 认为腔内治疗是一种可行、有效的方法, 而术后坚持长期有效的免疫抑制治疗是减少复发、降低死亡率的关键。该研究结果已发表在JVasc Surg杂志上, SCI影响因子达3.77。
Behcet(贝赫切特)病, 是一种多系统的慢性损害性综合征。临床症状主要有:复发性口腔溃疡、生殖器溃疡及复发性葡萄膜炎等。贝赫切特病伴有主动脉受累的患者, 临床上并不多见, 文献报道约为1.5% ~ 2.7%, 但死亡率高、预后极差, 未经手术治疗的患者多死于主动脉假性动脉瘤破裂。1998年Vasseur等首次报道通过分叉型支架植入成功治疗1例贝赫切特病合并主—髂动脉假性动脉瘤的患者, 证实了对此类患者腔内治疗的可行性。
北京协和医院血管外科自2002年4月始, 尝试对贝赫切特病主动脉假性动脉瘤进行腔内治疗, 截至2008年4月共积累了10例病例, 腔内治疗均获成功, 并在国内首先开展利用主动脉支架自行开窗植入治疗累及肾动脉的主动脉假性动脉瘤2例, 获得成功。10例患者中2例在术后出现支架近端假性动脉瘤复发, 这2例复发的患者均未坚持进行激素治疗。
通过对国内外多篇文献的总结, 并结合实际临床经验, 刘昌伟教授认为, 腔内治疗对于贝赫切特病合并主动脉假性动脉瘤是一种可行、有效的方法。而术后坚持长期有效的免疫抑制治疗亦十分必要, 能有效地减少复发、降低死亡率。
(北京协和医院血管外科 叶炜 刘暴，宣传处 陈明雁)
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