肾上腺组合性嗜铬细胞瘤四例报告及文献复习

目的 探讨肾上腺组合性嗜铬细胞瘤(嗜铬细胞瘤-神经节瘤)的临床特点及治疗方法.方法病理确诊的肾上腺组合性嗜铬细胞瘤患者4例,均为男性,年龄37～62岁.临床表现:高血压3例,其中伴有阵发性心悸1例;血压正常1例.B超、CT检查提示肿瘤均为单发,直径分别2.5、3.8、6.3、15.0 cm.行131Ⅰ-间位碘代苄胍显像检查2例,均为阳性;99Tcm-奥曲肽显像检查2例,阳性1例.24 h尿儿茶酚胺检查,去甲肾上腺素(196.1±92.2)nmol/24 h,肾上腺素(26.6±8.9)nmol/24 h,多巴胺(1957.9±913.5)nmol/24 h,其中轻度升高2例,正常2例.术前α受体阻滞剂准备2～4周.结果 3例行后腹腔镜下肾上腺肿瘤切除手术,1例行开放手术切除.病理报告:肾上腺组合性嗜铬细胞瘤.4例随访15～38个月,平均28个月,肿瘤未见复发、转移;3例高血压患者中2例血压正常.结论 肾上腺组合性嗜铬细胞瘤临床罕见,临床表现与嗜铬细胞瘤相似,儿茶酚胺稍升高,无恶性倾向,手术效果良好.     

腹腔镜治疗肾上腺外嗜铬细胞瘤

采用腹腔镜技术治疗肾上腺外嗜铬细胞瘤是一项全新的外科挑战,由于解剖复杂多变,手术操作过程中有儿茶酚胺释放的可能,使手术难度加大。作者报道1999至2 0 0 2年收治的5例后腹膜肾上腺外嗜铬细胞瘤患者利用腹腔镜切除肾上腺外嗜铬细胞瘤的经验。其中2例有vonHippel Lindau病史,3例为高血压偶然发现的肾上腺外嗜铬细胞瘤患者。4例有高血压病史者中2例有相关症状(一过性面部潮红、头痛、视物模糊)。5例术前血和尿中去甲变肾上腺素和(或)去甲肾上腺素水平显著升高,3例13 1I MIBG扫描阳性。术前均采用CT准确定位肿瘤。4例利用腹腔镜技术切除…     

机器人辅助腹腔镜下嗜铬细胞瘤切除术21例报告

目的:总结机器人辅助腹腔镜下嗜铬细胞瘤切除术的手术经验,探讨该术式的可行性及安全性。方法:2014年10月~2015年10月实施机器人辅助腹腔镜下嗜铬细胞瘤切除术21例,其中男11例,女10例。年龄22~72岁,平均52.2岁。肿瘤位于左肾上腺11例,右肾上腺7例,主动脉旁2例,右侧髂血管区1例。肿瘤最大径2.7~10.0cm,平均5.3cm。所有患者均完成术前定性定位检查,14例(66.7%)患者术前血儿茶酚胺升高。术前给予α阻滞剂治疗和扩容准备,记录手术方式、手术时间、出血量、住院时间等数据。结果:所有患者手术均在机器人辅助下完成,无中转开放手术者,无中转手助者。其中经腹径路手术18例,经腹膜后径路手术3例。手术时间1.50~3.38h,平均2.24h,中位手术时间2.18h。出血量10~1 000ml,平均141.4ml,中位出血量50ml。85.7%(18/21)的患者术中出现血压波动。住院时间7~22d,平均11.9d。术后1个月复查,所有术前儿茶酚胺升高的患者术后儿茶酚胺均恢复正常。结论:机器人辅助腹腔镜下嗜铬细胞瘤切除术是一种安全有效的治疗嗜铬细胞瘤的手术方式,可以按不同的肿瘤部位和大小选择经腹径路或经腹膜后径路。     

腹腔镜下切除无症状、生化正常的肾上腺嗜铬细胞瘤12例报告

目的:探讨无症状、生化检查正常的肾上腺嗜铬细胞瘤的诊治原则。方法:回顾分析12例无症状、生化检查正常的肾上腺嗜铬细胞瘤患者的临床资料,术前口服酚苄明1～2周,充分扩容,行腹腔镜肾上腺肿瘤切除术,其中经腰2例,经腹10例。结果:12例患者术中挤压肿瘤时血压均波动明显,手术一期完成,未发生大出血、心脑血管意外等严重并发症,无一例中转开放手术。术后病理均诊断为肾上腺嗜铬细胞瘤。随访6～36个月,血压正常,无复发。结论:无症状、生化检查正常的肾上腺肿瘤临床多见,术前按嗜铬细胞瘤进行准备,充分扩容后行腹腔镜手术是安全、有效的。     

后腹腔镜治疗12例肾上腺嗜铬细胞瘤回顾分析

目的评估后腹腔镜治疗肾上腺嗜铬细胞瘤的实用性。方法对12例肾上腺嗜铬细胞瘤患者行后腹腔镜手术治疗。平均直径3.6cm（2.5～6.2cm）,左侧5例,右侧7例。结果 12例手术均获成功、无手术并发症、术后临床症状和体征消失。平均手术时间为62±16min,平均出血量为58±13ml;瘤体直径为4.4±2.1cm。术后病理均证实为嗜铬细胞瘤。平均随访1.2年,除2例血压仍高外,其余患者临床症状和体征消失,生化检查24h尿儿茶酚胺（肾上腺素、去甲肾上腺素、多巴胺）及香草扁桃酸（VMA）均恢复正常。结论后腹腔镜治疗肾上腺嗜铬细胞瘤不失为一种可靠、安全的手术方法。术前充分的扩容和降压、术中熟练的操作及与麻醉师的良好配合是保证肾上腺嗜铬细胞瘤手术顺利完成的必要条件。     

腹膜后腹腔镜手术治疗静止型嗜铬细胞瘤的初步探讨

目的:探讨腹膜后腹腔镜手术治疗静止型嗜铬细胞瘤的临床疗效。方法:总结分析2002年～2008年我院施行腹膜后腹腔镜手术治疗静止型嗜铬细胞瘤9例患者的临床资料。结果:9例静止型嗜铬细胞瘤患者的血压、尿儿茶酚胺(DA)、肾上腺素(E)、去甲肾上腺素(NE)、尿香草基苦杏仁酸(VMA)均正常或略高于正常值,肿瘤直径2.0～4.5 cm,所有病例均行腹膜后腹腔镜肾上腺肿瘤切除术,其中3例术中血压无上升,4例轻度上升,2例发生高血压危象,无一例死亡。结论:静止型嗜铬细胞瘤在临床上有潜在的危险性,术前充分准备、术中及时妥善处理,腹膜后腹腔镜手术效果良好。     

后腹腔镜治疗肾上腺嗜铬细胞瘤16例

目的评价后腹腔镜肾上腺切除治疗嗜铬细胞瘤的临床价值。方法对我科2000年1月～2006年10月16例后腹腔镜治疗肾上腺嗜铬细胞瘤的临床资料进行回顾性分析。左侧10例，右侧6例，瘤体直径2．5～4．6cm，平均3．1cm。结果术前准备时间6～28d，平均11d。除1例因肿瘤周围粘连严重和出血中转开放外，其余15例均成功切除肿瘤，手术时间平均110min（90～170min），手术出血量平均135ml（80～650ml）。3例嗜铬细胞瘤切除后血压正常，术后即刻未用去甲肾上腺素溶液，其中2例分别在术后4和6h收缩压由135mmHg降至80mmHg，1例56h后收缩压突然由140mmHg降至85mmHg，立即应用去甲肾上腺素溶液维持血压正常。术后病理诊断15例为良性肾上腺嗜铬细胞瘤，1例开放者为低度恶性嗜铬细胞瘤，局部包膜浸润。术后平均住院12d（9～20d）。术后随访3～24个月，平均13个月，除1例需口服降压药外，其余血压均自然恢复正常，24h尿去甲肾上腺素、肾上腺素及儿茶酚胺含量均正常。结论后腹腔镜肾上腺切除是治疗嗜铬细胞瘤的有效方法，具有创伤小、并发症少及恢复快等优点。术前准备和术后处理在治疗嗜铬细胞瘤的过程中具有较重要的价值。     

巨大嗜铬细胞瘤15例的诊断和治疗

我科于 1990～ 2 0 0 0年共手术治疗肿瘤直径大于 10ｃｍ的巨大嗜铬细胞瘤15例。现报告如下。一、临床资料本组 15例 ,男 6例 ,女 9例。年龄2 8～ 72岁 ,平均 41 5岁。病程 2周～ 2 0年。病变部位 :左肾上腺 4例 ,右肾上腺9例 ,腹主动脉旁 2例。功能性嗜铬细胞瘤 10例 ,静止型嗜铬细胞瘤 5例。功能性嗜铬细胞瘤的血压范围在 140～30 0 / 94～ 180ｍｍＨｇ ,其中 6例 2 4ｈ尿儿茶酚胺升高 ,3例尿香草扁桃酸 (ＶＭＡ)升高。 5例静止型嗜铬细胞瘤患者 ,术前血压均在正常范围 ,仅 1例尿儿茶酚胺轻度升高 ,但尿ＶＭＡ正常 ,另 4例两者均在正常范…     

肾上腺嗜铬细胞瘤引起库欣综合征一例报告并文献复习

目的探讨肾上腺嗜铬细胞瘤引起库欣综合征的临床诊断和治疗。 方法结合文献复习,回顾性分析2015年12月我院收治的1例右侧肾上腺嗜铬细胞瘤引起库欣综合征患者的资料。患者女性,45岁,因反复头痛半年,加重伴头晕、多尿、消瘦2个月收入我院内分泌科。术前诊断考虑为肾上腺嗜铬细胞瘤引起库欣综合征,同时按库欣综合征和嗜铬细胞瘤做术前准备,行腹膜后入路腹腔镜右侧肾上腺肿瘤切除术。 结果内分泌检查示促肾上腺皮质激素（ACTH）、皮质醇高于检测值上限,且大、小地塞米松抑制试验不受抑制。血儿茶酚胺三项均升高,以肾上腺素为主,可乐定试验不受抑制。甲氧基肾上腺素及甲氧基去甲肾上腺素均升高。胸部CT平扫及PET-CT未发现可疑异位ACTH来源。肾上腺MR示双侧肾上腺内、外支弥漫性增厚,右侧肾上腺内、外侧支之间可见一类圆形肿块,边界清,考虑肾上腺嗜铬细胞瘤可能。予口服甲吡酮抑制皮质醇生成,常规剂量酚苄明作术前准备,行腹膜后入路腹腔镜右侧肾上腺肿瘤切除术。病理提示右侧肾上腺嗜铬细胞瘤,合并肾上腺皮质区带性增生。免疫组化CgA（+）,ACTH（+）。术后ACTH及皮质醇降至正常范围。术后6个月复查提示患者高血压、糖尿病等表现消失。 结论嗜铬细胞瘤引起库欣综合征是一种罕见疾病,手术切除是有效治疗手段,术前需同时按照嗜铬细胞瘤和库欣综合征完善术前准备。     

双侧肾上腺嗜铬细胞瘤并腹膜后副神经节瘤1例报告并文献复习

目的:探讨嗜铬细胞瘤及副神经节瘤的诊断和治疗。方法:诊治1例双侧肾上腺嗜铬细胞瘤并腹膜后副神经节瘤的患者。该患者同时患有高血压、Ⅱ型糖尿病,术前血浆及尿游离儿茶酚胺水平明显高于正常,CT检查提示双侧肾上腺富血供占位病变,腹膜后占位病变。结果:术前口服酚苄明降压及充分扩容后,全麻下行开放手术切除右侧肾上腺肿瘤,3个月后腹腔镜下切除左肾上腺肿瘤及腹膜后肿瘤。病理检查诊断为双侧肾上腺嗜铬细胞瘤、腹膜后副神经节瘤。患者术后半月余血糖恢复正常,血压较术前无明显变化,随访6个月无肾上腺皮质功能减退表现,未见肿瘤复发和转移。结论:提高认识、选择适当检查是诊断嗜铬细胞瘤和副神经节瘤的关键,进行充分的术前准备后手术切除肿瘤病灶是其首选治疗方法,术后应严格随访。     

Coarctation of the aorta in adults: surgical results and long-term follow-up

BACKGROUND: The aim of this retrospective study was to determine the impact of coarctation surgical repair on arterial blood pressure in adults more than 20 years of age. METHODS: Thirty-five adults (23 men), mean age 28.1 +/- 5.7 years (range, 21 to 52 years), underwent coarctation surgical repair between 1977 and 1997. All patients had preoperative hypertension. Mean systolic blood pressure was 178 +/- 37 mm Hg (range, 110 to 230 mm Hg). Thirty-three patients were taking at least one hypertension medication at the time of operation. All patients had preoperative catheterization and angiography (mean gradient across the coarctation was 62 +/- 27 mm Hg [range, 32 to 130 mm Hg]). Operative technique was resection and end-to-end anastomosis for 30 patients, resection with Dacron (C. R. Bard, Haverhill, MA) graft for 4 patients, and a prosthetic bypass graft for 1 patient. There were no hospital deaths and no late morbidity. RESULTS: All patients were reviewed. Follow-up was 165 +/- 56 months (range, 25 to 240 months). Of the 35 patients with preoperative hypertension, 23 were normotensive (systolic blood pressure < or = 140 mm Hg, diastolic blood pressure < or = 90 mm Hg) with no medication. Twelve patients were receiving medication: 6 required single-drug therapy and 6 patients required two drugs. Exercise testing was performed at an average of 6 +/- 4 months after repair and revealed hypertensive response to exercise in 8 of the 23 patients who were normotensive at rest and without medication. There were no recoarctation or repeat operations. Six aortic valve diseases were observed: three aortic incompetences (two bicuspid valves) treated by two valve replacements and one Bentall procedure, and three aortic stenoses (two valve replacements). No patient had evidence of a cerebrovascular accident. CONCLUSIONS: Surgical repair of coarctation in adults has proved to be an effective procedure and significantly reduces arterial hypertension. However, long-term surveillance is mandatory and should include exercise testing to identify patients with potential hypertension.     

Normotensive Pheochromocytoma: Institutional Experience

We report an audit of nine cases of subclinical or normotensive pheochromocytoma managed in our department. This is the first report from India of such a series. During the period 1990–2003 a total of 45 patients of pheochromocytoma were diagnosed and managed in the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences. Among them, nine patients were diagnosed as having subclinical or normotensive pheochromocytoma. Inclusion criteria for normotensive pheochromocytoma were: no previous history of hypertension clinically and, in the previous treatment documents, any episode of symptoms suggesting high blood pressure. The demographic profile, clinical presentation, biochemical investigations, imaging results, surgical notes, and follow-up record were reviewed retrospectively. All patients had a primary complaint of flank/abdominal pain and were normotensive. Seven had elevated urinary metanephrine levels, and one patient had normal values. One patient did not undergo the urinary metanephrine assay. Imaging of the abdomen showed seven adrenal and two extra-adrenal masses (eight had computed tomography scans of the abdomen, and one underwent ultrasonography). After selective α-adrenergic blockade (prazosin), surgery was performed. Six patients required infusion of sodium nitroprusside intraoperatively. The final histopathology was pheochromocytoma in all patients. Metanephrine levels were normal during the follow-up. Normotensive pheochromocytomas are a distinct entity, and all adrenal incidentalomas should be investigated for catecholamine hypersecretion. We support the use of preoperative α-adrenergic blockade, and these patients should be treated along the same lines as hypertensive pheochromocytoma.     

Late repair of coarctation of the descending thoracic aorta in 190 patients. Results up to 30 years after operation

Over a 30-year period, 190 consecutive patients had repair of coarctation of the descending thoracic aorta at a mean age of 25 years (range, 1 to 60 years); 130 were male. Median preoperative blood pressure (BP) was as follows: systolic, 160 mm Hg (range, 94 to 300 mm Hg) and diastolic, 90 mm Hg (range, 50 to 160 mm Hg). Dacron grafts were used in 64.7% of patients. Follow-up was obtained at a mean interval of 84.9 months, range, one to 360 months. Survival status was established for 86.1% (163/190) of patients. Postoperatively, the median BP was 133 mm Hg systolic (range, 90 to 195 mm Hg) and 80 mm Hg diastolic (range, 50 to 120 mm Hg). Overall, 80% of patients were either normotensive or had mild hypertension after operation. The best BP response and late survival were in patients operated on under 13 years of age. This study further confirms that early operation (below 5 years of age) is desirable. However, contrary to some previous reports, patients operated on as adolescents, despite some mild residual hypertension, had an excellent long-term prognosis. Patients over 21 years of age at operation had a high rate of persistent hypertension and experienced other serious cardiovascular complications.     

嗜铬细胞瘤临床功能分级与术前准备标准的探讨

目的　探讨嗜铬细胞瘤临床功能分级与术前准备的标准。方法　我院 1990年 1月至2 0 0 3年 11月手术治疗 172例嗜铬细胞瘤病例 ,根据术前临床症状、2 4h尿儿茶酚胺中去甲肾上腺素、肾上腺素和多巴胺水平将其临床功能分为 4级。功能 0级 2 2例 ,未给予扩容准备 ;功能 1级 17例 ,随机双盲法抽取 10例口服酚苄明 5～ 10mg/d持续 1周 ,其余 7例为对照 ,比较两者围手术期血压的变化 ;功能 2级 12 0例 ,术前口服酚苄明 30～ 2 4 0mg/d充分扩容 4周 ,应用血流动力学指标及微循环图像判断扩容效果 ;功能 3级 13例 ,应用酚苄明及相应的心肺脑复苏措施。全部病例均在全麻下行肿瘤探查切除术。结果　功能 0级者围手术期血压平稳。功能 1级者血压均有波动 (<80mmHg) ,酚苄明治疗者波动幅度 <2 0mmHg ,对照者 >4 0mmHg(χ2 值为 13 12 ,P <0 0 1)。功能 2级和 3级者血压波动幅度 >80mmHg ,术后 2 4h内血流动力学恢复正常 ,无并发症。结论　根据嗜铬细胞瘤功能分级可采取不同的术前准备 ,功能 0级无需扩容 ,功能 1级可口服酚苄明 5～ 10mg/d持续 1周 ,功能 2级必须应用酚苄明 30～ 2 4 0mg/d充分扩容 4周 ,功能 3级必须心肺脑复苏加充分扩容 ,心肺脑功能基本正常后方可手术。血压正常和微循环图像显示微动脉充分扩张是     

Surgical management of pheochromocytoma with the use of metyrosine.

Despite recommended preoperative preparation with alpha-adrenergic blockers, severe hemodynamic instability may occur during operations to resect pheochromocytoma. We combined the alpha-blocker phenoxybenzamine with the tyrosine hydroxylase inhibitor metyrosine in an attempt to better manage the hypertension of patients with pheochromocytoma undergoing surgical resection. This report reviews the cases of 25 consecutive patients undergoing surgery for known intra-abdominal pheochromocytoma. Each patient had elevated serum or urine levels of catecholamines or their metabolites. Nineteen patients were prepared before operation with phenoxybenzamine and metyrosine and six patients were given phenoxybenzamine alone. There were no significant differences in maximum, minimum, or mean blood pressure before or after tumor resection between patients who received metyrosine and those who did not. However careful review suggested that those who received metyrosine had more severe disease as judged by biochemical criteria. Study of selected patients matched for age and severity of disease suggested that the intraoperative blood pressure management of patients prepared with phenoxybenzamine and metyrosine was facilitated. In addition metyrosine-prepared patients lost less blood and required less volume replacement during surgery than did non-metyrosine-prepared patients. There were no apparent differences in postoperative fluid requirements. Although the study is not a prospective randomized trial, a retrospective review of patients managed with the combination of phenoxybenzamine and metyrosine suggests that surgery to resect pheochromocytoma can be better performed with both drugs than with phenoxybenzamine alone. The combination regimen appears to result in better blood pressure control, less blood loss, and the need for less intraoperative fluid replacement than does the traditional method of single-agent alpha-adrenergic blockade.     

Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy.

Arterial pressure regulation is often labile following carotid endarterectomy. Hemodynamic data from 100 consecutive endarterectomies allowed definition of three distinct postoperative blood pressure responses. A hypotensive response (group I) affected 28 patients in whom mean arterial pressure decreased from 168 +/- 29/90 +/- 15 mm Hg before operation to 110 +/- 21/68 +/- 16 mm Hg after operation (P less than 0.001). Maximum hypotension occurred 5.3 hours after endarterectomy. The preoperative pulse, 80 +/- 9 beats/min, fell to a low of 64 +/- 12 beats/min after operation (P less than 0.001). A significant hypertensive response (group II) affected 19 patients in whom mean blood pressure rose from 160 +/- 29/87 +/- 15 to 223 +/- 32/110 +/- 22 mm Hg (P less than 0.001). Maximum hypertension was noted 2.3 hours after endarterectomy. This was unaccompanied by significant pulse changes. Fifty-three patients remained normotensive (group III). Their preoperative blood pressure (150 +/- 14 mmHg). Fluctuations in pressure did not correlate with age, indication for operation, or degree of ipsilateral and contralateral carotid arterial stenosis. Postendarterectomy hypotension and hypertension appear to represent transient baroreceptor dysfunctions.     

肝移植术后患者早期呼吸机脱机延迟的术前及术中危险因素

Objective To evaluate the pre- and intra-operative risk factors associated with delayed weaning from ventilator during the early postoperative period in patients undergoing liver transplantation.Methods Two hundred and twelve patients (152 male, 60 female) aged 22-69 yr undergoing liver transplantation from Sept 2004to Aug 2006 were enrolled in this study and were divided into 2 groups according to the time when the patients were weaned from ventilator: normal weaning group (Group A, the patients weaned from ventilator within 24 h after operation) and delayed weaning group (Group B, the patients weaned from ventilator more than 24 h after operation). Routine anesthesia wes performed. Blood and blood products were transfused according to the guidelines for blood transfusion to maintain the mean arterial pressure (MAP)≥60 mm Hg during operation. Sixteen preoperative variables (age＞64 yr, gender, BMI ≥ 30kg/m2, PaO2＜75 mm Hg,pleural effusion, a history of asthma, smoking, drinking alcohol, coronary artery disease, diabetes mellitus, encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepatopulmonary hypertension) and 7 intraoperative variables (duration of operation, duration of anhepatic stage, transfusions of RBC,fresh frozen plasma (FFP), crystalloid and colloid, and urine output＜ 1 ml·kg-1·h-1) were recorded and compared between the two groups.Results There were significant differences in 9 preoperative variables (age ＞ 64 yr, PaO2＜75 mm Hg, pleural effusion,encephalopathy＞grade 3, spontaneous bacterial peritonitis, preoperative MELD score, serum albumin, ascites≥20 ml/kg and moderate hepato-pulmonary hypertension) and 5 intraoperative variables (transfusions of RBC, FFP, crystalloid and colloid, and urine output＜1 mi·kg-1·h-1) between the two groups (P＜0.05 or 0.01). And logistic regression analysis showed that 5preoperative variables (age＞64 yr, PaO2＜75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, and moderate hepato-pulmonary hypertension) and 2 intraoperative variables (transfusion of RBC and urine output＜1 ml·kg-1·h-1) were confirmed to be associated with delayed weaning from ventilator.Conclusion Such variables es age ＞ 64 yr, preoperative PaO2 ＜ 75 mm Hg, encephalopathy ＞ grade 3, preoperative MELD score, moderate hepato-pulmonary hypertension, transfusion of RBC during operation and urine output ＜ 1 ml· kg-1 · h-1 are associated with delayed weaning from ventilator during early postoperative period after liver transplantation.     

A clinical review of 30 pheochromocytoma patients

A study of 30 cases of pheochromocytoma encountered at our department between 1959 and 1986 is presented. Fourteen patients were males and 16 were females. Their ages ranged from 18 to 72 years with a peak incidence in the fifties. Hypertension was present in 87% of the patients. The incidence of extra-adrenal tumors was 30% and that of malignancy 7%. The 24-hr urinary level of catecholamine was to a certain degree in accord with the location of the tumor and type of hypertension. Computed tomography and venous sampling were very useful for the diagnosis which had an accuracy rate of 100% in this series. Preoperative management using an alpha-blocker was effective in controlling blood pressure and circulating blood volume in most cases. Postoperative blood pressure was normalized within a week after operation in 85% of the patients who had been suffering from hypertension, although elevated levels of norepinephrine in urine were still noted in 56% of the patients one week after operation. Of the 27 follow-up cases, 21 cases (78%) were in good health and 2 cases were alive with hypertension with a mean follow-up period of 8.1 years. Four patients died, one during angiography, one of pulmonary edema one day after operation and the other 2 of metastases of malignant pheochromocytoma.     

腹腔镜切除5～10 cm肾上腺嗜铬细胞瘤的安全性分析

目的 探讨5～10 cm肾上腺嗜铬细胞瘤腹腔镜切除术的安全性. 方法 2001年1月至2007年6月在北京大学第一医院泌尿外科行肾上腺嗜铬细胞瘤切除的连续79例患者中肿瘤最大径5～10 cm者共41例,回顾分析其临床资料.腹腔镜组11例(其中2例中转开放,数据分析时排除在外),开放手术组30例.应用t检验、Mann-Whitney U检验对两组患者的临床资料及围手术期数据进行分析. 结果 两组患者年龄、肿瘤最大径、术前最高收缩压及舒张压、术前心率、血儿茶酚胺水平的差异均无统计学意义(P>0.05).腹腔镜组均经腹膜后途径.开放手术组经腹腔途径11例,经腹膜后途径19例.两组患者手术时间分别为(132±54)min和(178±64)min;术中出血量分别为100 ml(0～800 m1)和450 ml(0～9500 ml);术后住院时间分别为(7±2)d和(9±4)d,差异均有统计学意义(P<0.05).腹腔镜组术中均未输血,开放手术组术中输血量的中位值为225 ml(0～3800 ml).2组患者术中最高血压、最低血压、最快心率、最慢心率、收缩压增加基础血压30%的次数、收缩压≥200 mm Hg(1 mm Hg=0.133 kPa)次数、收缩压≤90 mm Hg次数、心率≥110次/min次数、心率≤50次/min次数的差异均无统计学意义(P>0.05).两组患者引流量、拔管时间、住ICU时间、术后开始进食时间、住院费用差异均无统计学意义(P>0.05). 结论 腹腔镜切除5～10 cm肾上腺嗜铬细胞瘤的手术时间、术中出血量、术中输血量、术后住院日较开放手术有优势,且术中血压、心率波动等指标不高于开放手术.因此,5～10 cm的肾上腺嗜铬细胞瘤不是腹腔镜的绝对禁忌,经验丰富的术者可以考虑开展腹腔镜手术切除较大肾上腺嗜铬细胞瘤.