A case of retroperitoneal bronchogenic cyst treated by laparoscopic surgery

We describe herein a rare case of a retroperitoneal bronchogenic cyst successfully treated by laparoscopic surgery. A 39-year-old man with low-grade fever was referred to our hospital because of suspicion of an adrenal tumor. Abdominal computerized tomography (CT) and ultrasonography revealed a homogenous solid mass, 35 x 30 mm in diameter, in the left suprarenal region. Laboratory studies showed that the levels of adrenal hormones were normal except for the white blood cell count of 9,700/microL and C-reactive protein of 1.7 mg/dl. We diagnosed it as a non-functioning adrenocortical adenoma or an adrenal cyst. However, one year later he underwent laparoscopic surgery because the mass had gradually increased by 10 mm and the low-grade fever persisted. Pathological evaluation of the surgical specimens established the diagnosis of retroperitoneal bronchogenic cyst. The low-grade fever disappeared after the surgery.     

Perirenal venous aneurysm presenting as retroperitoneal tumor treated successfully by laparoscopic excision

We describe an unusually located venous aneurysm found incidentally in a 46-year-old man that was presumptively diagnosed as a retroperitoneal mass near the left renal hilum. He presented for constipation and weight loss; an abdominal ultrasound scan disclosed an anechoic lesion in the left retroperitoneum. Abdominal CT showed a 3-cm mass with low density located at the junction of the left para-aortic and perirenal hilar regions that was initially suspected of being metastatic lymphadenopathy with an unknown primary origin or a neurogenic tumor. The mass was resected by a laparoscopic approach, which revealed a round mass with a smooth capsule and roots connecting to the paraspinal muscles. On pathologic examination, the mass showed classic features of a venous aneurysm. At 12-month follow-up, no local recurrence or malignancy was documented.     

Primary retroperitoneal teratoma presenting as an adrenal tumor in an adult

Primary teratomas in the retroperitoneum are rare in adults. Most teratomas in this region are secondary to germ cell tumors of the testes or ovaries. We describe a case of mature cystic teratoma that was clinically suggestive of an adrenal myelolipoma. Resection was attempted using laparoscopy but was converted to open adrenalectomy to ensure complete resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 18 months.     

A retroperitoneal bronchogenic cyst: laparoscopic treatment

Subdiaphragmatic bronchogenic cysts are rare, and those located retroperitoneally are exceptional. We describe a retroperitoneal cyst presenting as an asymptomatic adrenal mass which was treated with laparoscopic surgery with three trocars.     

Retroperitoneal foregut duplication cyst presenting as an adrenal mass

A 75 year-old woman presented to the authors' institution with abdominal pain and early satiety. An adrenal mass was found on CT scanning. Laparoscopic adrenalectomy was performed, and the patient was found to have a retroperitoneal bronchogenic cyst adherent to the adrenal gland. The workup of an adrenal mass is discussed as well as the pathophysiology of bronchogenic cysts.     

应用腹膜后腹腔镜手术治疗肾上腺囊肿(附27例报告)

目的:探讨腹膜后腹腔镜手术治疗肾上腺囊肿的方法及临床意义。方法:回顾分析2000年3月至2008年7月采用腹膜后腹腔镜手术治疗肾上腺囊肿27例患者的临床资料。结果:所有手术均获成功,21例行肾上腺部分切除术,6例行肾上腺全切除术,手术时间平均(35.1±11.6)min,术中平均出血(27.9±13.6)ml,平均住院(4.3±1.8)d。术后无严重并发症发生,随访12～36个月,无一例复发。结论:腹膜后腹腔镜手术可作为治疗肾上腺囊肿的标准术式。     

Benign retroperitoneal schwannoma presenting as a giant adrenal tumor

We report a 51-year-old man with a primary adrenal tumor presenting as a giant juxta-adrenal benign schwannoma. The patient was initially admitted for persistent fevers and underwent a sepsis workup. Abdominal ultrasound initially revealed an incidental right suprarenal mass, which measured 10 x 10 x 11 cm, estimated by computed tomography. Following a successful laparotomy, histologic examination confirmed that this giant tumor was a benign retroperitoneal schwannoma. Postoperatively, the patient remains disease-free, undergoing rehabilitation.     

Retroperitoneal bronchogenic cyst as a differential diagnosis of pancreatic mucinous cystic tumor

Cystic tumors of the pancreas where a pseudocyst has not been able to be excluded has been considered potentially proliferative and pre-malignant or malignant and thus aggressive surgical approach has been advocated. Retroperitoneal cystic tumors are rare and among these bronchogenic cysts are extremely infrequent. The present paper describes a case of bronchogenic cyst in association with the pancreas in which diagnostic work-up was not able to exclude a proliferative pancreatic cystic tumor.     

后腹腔镜手术与开放肾上腺嗜铬细胞瘤手术疗效的比较

目的:评价后腹腔镜手术治疗肾上腺嗜铬细胞瘤的临床效果。方法:对后腹腔镜手术治疗肾上腺嗜铬细胞瘤患者19例(后腹腔镜手术组)与同期行开放手术治疗肾上腺嗜铬细胞瘤患者14例(开放手术组)进行疗效比较。结果:后腹腔镜手术组:19例均成功;肿瘤最大直径1.8~9.5(4.1±1.7)cm;手术时间40~180(90±35)min;出血量15~100(40±25)ml;术后止痛剂应用次数1次;术后下床活动时间2~4(2.1±0.4)天;术后住院时间4~8(6.0±1.5)天。开放手术组:14例均成功;肿瘤最大直径2.1~11.5(3.9±1.5)cm;手术时间95~260(140±41)min;出血量100~700(310±118)ml,6例输血;术后止痛剂应用次数5次;术后下床活动时间4~7(5.1±0.9)天;术后住院时间8~12(9.1±1.2)天。结论:对有较丰富腹腔镜手术经验的术者,后腹腔镜肾上腺嗜铬细胞瘤手术显著优于传统开放手术,具有安全、有效、创伤小、疼痛轻、康复快、住院时间短等优点,可作为治疗肾上腺嗜铬细胞瘤的首选方法。     

后腹腔镜去顶减压术在多囊肾的应用

目的评价后腹腔镜去顶减压术治疗成人型多囊肾的临床价值。方法2004年4月至2007年1月应用后腹腔镜去顶减压术治疗成人型多囊肾患者15例。结果所有手术均获成功。平均手术时间60min，手术失血量30～100ml，术后平均住院时间4d。随访10～32个月，15例腰痛患者中13例腰痛减轻，10例血压升高者6例血压下降至正常范围，另有2例血压下降超过10mmHg，血清肌酐（Cr）下降10μmol／l以上者10例。未发生严重并发症。结论后腹腔镜囊肿去顶减压术治疗成人型多囊肾疗效好，创伤小，恢复快，是目前成人型多囊肾较好的治疗手段。     

腹膜后腹腔镜肾上腺手术的学习曲线

目的:探讨腹膜后腹腔镜肾上腺手术的学习曲线。方法:回顾分析2001年11月至2009年8月同一术者完成的200例腹膜后腹腔镜肾上腺手术的临床资料,按先后顺序按每组40例分为5组。观察每组手术时间,进行方差分析,比较组间差异。结果:通过描述统计可见,随例数增加,手术时间呈缩短趋势。5组间,后4组手术时间有明显差异,后3组差异无统计学意义。结论:具有丰富开腹手术经验的术者,约80例的腹膜后腹腔镜肾上腺手术是此手术的学习曲线。     

后腹腔镜保留肾脏手术治疗肾肿瘤

目的探讨后腹腔镜保留肾脏手术治疗肾肿瘤的手术方法和临床效果。方法采用后腹腔镜技术使用超声刀对13例肾良性肿瘤和5例肾恶性肿瘤患者分别行肿瘤剜除术和肾楔形切除术。男7例，女11例。平均年龄51岁。肿瘤直径1．5～4．0cm，平均2．8cm。观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果18例手术均获得成功。平均手术时间87min，平均出血量55ml，平均术后住院时间5．8d。围手术期无并发症。病理检查5例恶性肿瘤切缘阴性，平均随访10个月无局部复发。结论后腹腔镜肾部分切除术安全可行，切除肿瘤精确彻底，创伤小，恢复快，值得临床有选择地推广使用。     

Retroperitoneal dermoid presenting as an infected pancreatic cyst

Bacteroides fragilis infection of a juxtapancreatic benign cystic retroperitoneal teratoma in a 28 year old Chinese male is reported. Preliminary drainage was followed by excision. The radiological and pathological findings of this rare tumour are reported with emphasis on the differential diagnosis which includes inflammatory and neoplastic pancreatic cysts.     

后腹腔镜保留肾单位术治疗肾肿瘤

目的:探讨后腹腔镜保留肾单位术治疗肾肿瘤的手术技巧。方法:采用后腹腔镜技术对9例肾错构瘤和2例局限性肾癌患者分别行肿瘤剜除术和肾楔形切除术。肿瘤直径1.5~3.0cm,平均2.5cm。观察手术时间、术中出血量、术后住院天数和围手术期并发症及手术效果。结果:11例手术均获得成功。平均手术时间110min,平均出血量70ml,平均术后住院时间5天。围手术期无并发症。病理检查2例恶性肿瘤切缘阴性,平均随访10个月无局部复发。结论:后腹腔镜保留肾单位术治疗肾肿瘤安全可行,创伤小,恢复快,能有效切除肿瘤和保留肾功能。     

Mediastinal bronchogenic cyst presenting with pericardial effusion

We report a case of a 58-year-old woman who had a bronchogenic cyst presenting with pericardial effusion. Initially, the effusion had disappeared prior to resection of the cyst, but it reappeared with additional symptoms. Resection of the bronchogenic cyst resulted in complete resolution of the pericardial effusion and additional symptoms such as progressive dyspnea and chest pain. Application of surgical treatment for asymptomatic cysts in adults remains controversial, but we recommend that mediastinal cysts which present with any symptoms should be resected at the time of their discovery, even though the symptoms disappeared for a while.