右侧肾上腺肿瘤的辅助显露方法

目的：探讨右侧肾上腺肿瘤的手术技巧。方法：术中切断8例患者的部分肝脏韧带，向左旋转肝脏，充分显露肿瘤及肝后腔静脉。结果：8例均获完整切除，效果较好。结论：切断部分肝脏韧带，有助于显露肿瘤，可免除胸腔联合切口，提高切除率，降低手术风险。     

Successful one-stage surgical removal of intravenous uterine leiomyomatosis with right heart extension

We report a 49-year-old woman with intravenous and intracardiac extension of uterine leiomyomatosis. After subtotal hysterectomy and salpingo-oophorectomy, an intravenous and intracardiac tumor was removed under normothermic cardiopulmonary bypass without cardiac arrest. Postoperatively, occlusion of the artery supplying the remaining uterine cervical stump was performed by the catheter coiling technique. More than 2 years after surgery, the patient is well without recurrence.     

Robotic adrenalectomy for a large right adrenal tumour

The robotic approach for adrenalectomy has revolutionized the field of minimal access surgery for benign adrenal tumours. Robotic adrenal surgery has the edge over conventional laparoscopic adrenal surgery as it provides 3D stereoscopic vision, a high degree of dexterity with the use of EndoWrist instruments, and an ergonomic position for the surgeon. Here, we present our experience with robotic adrenal surgery in a large right adrenal tumour.     

Laparoscopic resection of a large right adrenal gland cyst

A case of a benign cyst of the right adrenal gland resected laparoscopically is presented. The approach was through the right subcostal space mobilizing the right lobe of the liver and the right colonic flexure. The procedure was of 75 min duration and was uneventful. The patient was discharged the 3rd postoperative day free of postoperative pain. The advantages and disadvantages of this new modality for the treatment of adrenal gland cysts are discussed.     

Laparoscopic removal of pheochromocytoma

Until now, the need for wide exposure and nonmanipulative dissection of pheochromocytoma has dictated the use of a large intraperitoneal transabdominal approach, which unfortunately results in a significant incidence of morbidity. A unilateral retroperitoneal approach guided by the refinements of new imaging techniques is less invasive but is associated with a small risk of incomplete cure. In one case report, we tested the hypothesis that laparoscopic surgery could combine the beneficial effects of both operative strategies without their respective side effects. We concluded that a laparoscopic approach combined with exclusive intraoperative infusion of nicardipine, a calcium-channel blocker, can be used to surgically remove pheochromocytoma under stable hemodynamic conditions. This provides better exposure of the anatomical structures than open surgery and allows a visual exploration of the entire abdominal cavity to exclude tumor multicentricity or ectopic sites in the case of inconclusive preoperative imaging investigations. Moreover, conversion to open surgery is always possible if needed.     

Spontaneous rupture of adrenal pheochromocytoma with capsular invasion

A 67-year-old Japanese man developed a sudden onset of severe right-side upper abdominal pain, nausea and vomiting. On hospitalization, physical examination revealed sweating, tachycardia, hypertension and the appearance of peripheral vasoconstriction. An urgent computed tomography scan with contrast demonstrated a large hematoma in the right retroperitoneal space. A phentolamine test and an 131iodine metaiodobenzylguanidine scan suggested pheochromocytoma. An elective right adrenalectomy was successfully performed after pretreatment for sufficient volume replacement with continuous administration of alpha- and beta-adrenergic blocking agents. Pathological diagnosis was an adrenal pheochromocytoma 9.0 x 6.5 cm in diameter with evidence of capsular invasion, which could be associated with a tear in the capsule.     

Association of pheochromocytoma with contralateral nonfunctioning adrenal adenoma

A 52-year-old woman complaining of abdominal pain, headaches and palpitations was admitted to our hospital for investigation of a bilateral adrenal tumor. Bilateral adrenalectomy was subsequently performed. The definitive diagnosis was right pheochromocytoma and left adrenocortical adenoma. Only four cases of pheochromocytoma associated with nonfunctioning adrenal adenoma have previously been reported. The coexistence of both entities is currently believed to be coincidental. Further examination of cases similar to ours might reveal the underlying mechanisms for the coexistence of these tumors.     

肾上腺嗜铬细胞瘤诊治40年临床总结

目的：提高肾上腺嗜铬细胞瘤的诊治水平。方法：总结1958－1998年间经手术治疗的肾上腺嗜铬细胞瘤220例临床资料。其中有高血压表现201例,静止型肾上腺嗜铬细胞瘤19例;双侧肾上腺嗜铬细胞瘤15例,家族性嗜铬细胞瘤4例,MEN－Ⅱ型2例,Von Hippel0Lindau病2例,恶性嗜铬细胞瘤7例,结果：218例患者均经手术治疗,2例因手术困难仅作活检;手术死亡2例。结论：明确的术前诊断可提高静止型嗜铬细胞瘤的手术安全性,良好的术前准备可减少儿茶酚胺心肌病的并发症,手术径路的选择须以影像学资料为依据。     

A case of adrenal pheochromocytoma with contralateral adrenocortical adenoma

A case of a pheochromocytoma in the right adrenal gland and adrenocortical adenoma in the left adrenal gland of a 58-year-old male is reported. The patient was incidentally found to have a right adrenal tumor by ultrasonographic study. A computerized tomographic (CT) study and magnetic resonance image (MRI) study revealed bilateral adrenal tumors. The sizes of the right tumor and left tumor were 2.5 x 3.5 cm and 1.2 x 1.0 cm, respectively. The intensity of each tumor was different on T2-weighted MRI. 131I-MIBG scintigram showed the uptake of right adrenal gland. The existence of pheochromocytoma was confirmed by the elevated levels of catecholamines. We performed venous sampling to be certain whether the patient had unilateral or bilateral pheochromocytoma. As a result, bilateral adrenal pheochromocytoma was diagnosed. Therefore, we performed bilateral adrenalectomy. However, histopathological examination revealed right pheochromocytoma and left non-functioning adrenocortical adenoma.