两种腹腔镜手术路径治疗儿童肾上腺区神经母细胞瘤的经验总结CSCD

目的评估两种腹腔镜手术路径治疗儿童肾上腺区神经母细胞瘤的可靠性及安全性。方法回顾性分析2018年2月至2020年8月江西省儿童医院9例腹腔镜下行手术治疗的肾上腺区神经母细胞瘤患儿临床资料,其中男6例,女3例;年龄1个月至5岁5个月,平均年龄22个月。6例为右侧肾上腺区神经母细胞瘤,3例为左侧肾上腺区神经母细胞瘤。临床表现:2例为腹痛,1例为血尿,1例为腹泻,1例为腹胀,4例为体检发现。结果9例术前经增强CT及彩超检查诊断为肾上腺区肿瘤,与周围脏器无浸润,下腔静脉无瘤栓;8例无淋巴结及远处转移,1例肝脏转移;内分泌检查均为无功能性肿瘤。9例中7例经腹腔途径手术,2例经腹膜后途径手术;9例均顺利、完整切除肿瘤,无一例中转开放手术,平均手术(腹腔镜操作)时间137 min,平均出血16.3 mL(5~40 mL),1例输血100 mL,肿瘤平均直径4.3 cm(2.5~5.4 cm)。术后病理检查结果:5例神经母细胞瘤,3例节细胞神经母细胞瘤,1例节细胞神经瘤。术后均恢复良好,Ⅰ期病例未行化疗,Ⅳ期肝脏转移病例术后予化疗,平均随访时间8.6个月(2~35个月),无一例复发。结论两种腹腔镜手术路径切除儿童肾上腺区神经母细胞瘤均安全、有效,腹膜后途径在显露及血管处理上更具优势,腹腔途径在操作空间上更具优势。

Two different surgical approaches of laparoscopic adrenalectomy for children with adrenal neuroblastomaCSCD

Objective To evaluate the reliability and safety of two different surgical approaches of laparoscopic adrenalectomy for children with adrenal neuroblastoma. Methods A retrospective study was performed for five children undergoing laparoscopic adrenalectomy from February 2018 to August 2020. There were 6 boys and 3 girls with an average age of 22(1-65) months. The involved side was left (n =3) and right (n = 6). There were abdominal pain (n = 2),hematuria (n = 1),diarrhea (n = 1),abdominal distension (n = 1) and non-discomfbrt (n = 4). Retroperitoneal (n =2) and tiansperitoneal (n = 3) laparoscopies were performed. All procedures were successfully performed without any conversion into open surgery. The average operative duration was 137 min,the mean estimated volume of blood loss 16. 3(5 -40) ml and the mean tumor diameter 4.3(2.5 -5.4) cm. Histopathological examination hinted at neuroblastoma (n =5),ganglioneuroblastoma (n=3) and ganglioneuroma (n = 1). Results All of them recovered well postoperatively during a mean follow-up period of 8.6(2-35) months. There was no onset of recurrence or metastasis. Conclusion Two different approaches of laparoscopic adrenalectomy may be safely and effectively performed for neuroblastoma. Retroperitoneal laparoscopy offers an advantage over exposing and handling blood vessels while transperitoneal laparoscopy is superior for operating space. © 2022, Science and Technology Association of Hunan Province. All rights reserved.