腹腔镜下经肠系膜途径左侧肾上腺巨大嗜铬细胞瘤切除术五例报告

目的探讨腹腔镜下经肠系膜途径切除左侧肾上腺巨大嗜铬细胞瘤的可行性和安全性。 方法选取2017年8月至2018年10月我院左侧肾上腺巨大嗜铬细胞瘤5例患者，肿瘤直径6.5～10.5 cm，平均8.2 cm，3例有阵发性高血压，2例无明显自觉症状。采用经腹腹腔镜经肠系膜入路，于结肠脾曲内侧肠系膜根部肿瘤隆起处纵向切开系膜及后腹膜，显露游离并切除肿瘤，注意避免损伤肠管和肠系膜血管。 结果手术均取得成功，手术时间95～180 min，平均155 min；术中出血量为50～300 ml，平均为180 ml；术后重症监护室监护1～2 d，术后第2～3天患者即可下地活动，术后1～3 d肠道功能恢复，2～4 d拔除引流管，术后8～12 d出院，平均9.5 d，术后随访4～18个月，3例术前有高血压者术后阵发性高血压等症状缓解，无并发症发生。 结论对于左侧肾上腺巨大嗜铬细胞瘤，经腹腹腔镜经肠系膜入路肾上腺嗜铬细胞瘤切除术是可行和安全有效的。

Transmesenteric laparoscopic adrenalectomy for treatment of giant pheochromocytoma on left side: Five cases report

ObjectiveTo evaluate the feasibility and safety of transmesenteric laparoscopic adrenalectomy for treatment of giant pheochromocytoma on left side. MethodsFrom August 2017 to October 2018, 5 cases of giant pheochromocytoma on left side were hospitalized, the tumor diameter was 6.5-10.5 cm, with an average of 8.2 cm, 3 cases of them had a history of paroxysmal hypertension and the other 2 cases had no obvious symptoms. Transmesenteric laparoscopic adrenalectomy was performed via mesentery longitudinally at the medial mesenteric, tumor was well exposed and easy to remove. Be tender to protect the intestinal and mesenteric vessels. ResultsAll 5 procedures were well performed. The operation time was 95-180 min, with an average of 155 min. The intraoperative blood loss was 50-300 ml, with an average of 180 ml. All cases were admitted to ICU for 1-2 days after procedures. The intestinal function recovered 1-3 days after operation, and the drainage tube was removed 2-4 days after operation. The postoperative hospitalization was 8-12 days, with an average of 9.5 days. Postoperative follow-up was 4-18 months, 3 cases with preoperative paroxysmal hypertension were all relieved after operation, and no complications occurred. ConclusionFor the treatment of giant pheochromocytoma on left side, transmesenteric laparoscopic adrenalectomy is feasible, safe and effective.