腹腔镜手术治疗肾上腺嗜铬细胞瘤及副神经节瘤:附211例报告

李汉忠; 文进; 纪志刚; 肖河; 严维刚; 徐维锋; 曾正陪; 黄宇光; 刘大为

腹腔镜手术治疗肾上腺嗜铬细胞瘤及副神经节瘤:附211例报告

Laparoscopic Surgery for Adrenal Pheochromocytoma and Paraganglioma:Report of 211 Cases

摘要

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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