双侧肾上腺嗜铬细胞瘤同期与分期切除的疗效分析

目的比较双侧肾上腺嗜铬细胞瘤（PHEO）同期切除与分期切除的疗效。方法回顾性分析43例接受手术治疗的双侧肾上腺PHEO患者的临床资料，根据手术方式的不同将患者分为同期切除组（双侧PHEO同期切除，n=23）和分期切除组（双侧PHEO分期切除，n=20），对两组患者的基线资料以及术中和术后相关指标的检测结果进行比较。结果同期切除组患者均行开放手术。在分期切除组中，双侧肿瘤均行开放手术16例，一侧行开放手术、另一侧行腹腔镜手术2例，双侧肿瘤均行腹腔镜手术2例。同期切除组和分期切除组中开放手术患者的手术时间分别为3．66h和2．11h（P〈0．05），出血量分别为1680．00mL和276．92mL（P〈0．05），术中大幅血压波动发生率分别为52．17％和18．67％．（P〈0．05），术后暂时性肾上腺皮质功能不全发生率分别为82．61％和44．44％（P〈0．05），术后住院时间分别为12．07d和10．41d（P〉0．05），左侧肿瘤直径分别为4．32cm和5．64cm（P〉0．05），右侧肿瘤直径分别为5．10cm和4．01cm（P〉0．05）。两组术后平均随访9．30年（4个月-27年），同期切除组和分期切除组分别有6例（26．1％）和3例（15．O％）复发。结论与同期切除比较，双侧PHEO分期切除的术中安全性高、术后恢复快、并发症少、复发率低，可能是双侧肾上腺PHEO患者，尤其是高危患者的理想术式。

Analysis of therapeutic effects of simultaneous resection and staged resection of bilateral adrenal pheochromocytomas

Objective To compare the bilateral adrenal pheochromocytomas. therapeutic effects of simultaneous Methods Clinical data of 43 resection and staged resection of patients whose bilateral adrenal pheochromocytomas were surgically treated was analyzed retrospectively. Patients were divided into the simultaneous resection group （bilateral adrenal pheochromocytomas were simultaneously resected, n =23） and staged resection group （bilateral adrenal pheochromocytomas were resected in stages, n =20） according to different surgical procedures. Baseline characteristics and testing results of perioperative and postoperative indexes of the two groups were compared. Results All patients of the simultaneous resection group underwent open surgeries. For the staged resection group, 16 patients underwent open surgeries for both pheochromocytomas; 2 patients underwent open surgeries for one pheochromocytoma and laparoscopic operations for the other pheochromocytoma; and 2 patients underwent laparoscopic operations for both pheochromocytomas. The operative time, volumes of blood loss, incidences of intraoperative significant fluctuation of blood pressure, incidences of postoperative transient adrenocortical insufficiency, postoperative hospitalization time, left tumor sizes, and right tumor sizes of patients undergone open surgeries of the simultaneous resection group and staged resection group were 3.66 h and 2.11 h （P〈0.05）, 1 680 mL and 276.92 mL （P〈0.05）, 52.17% and 18.67% （P〈0.05）, 82.61% and 44.44% （P〈0.05）, 12.07 d and 10.41 d （P〉0.05）, 4.32 cm and5.64 cm （P〉0.05）, 5.10 cm and 4.01 cm （P〉0.05）, respectively. The average follow-up time of two groups was 9.3 years （ from 4 months to 27 years）. The recurrences of the simultaneous resection group and staged resection group were 26.1% （6 cases） and 15% （3 cases）. Conclusion Compared to the simultaneous resection, the staged resection of bilateral adrenal pheochromocytomas shows higher perioperative safety, shorter postoperative convalescence, less complications, and lower recurrence and may be an ideal surgical procedure for patients with bilateral adrenal pheochromocytomas, especially for patients with high risk.