两种不同入路的腹腔镜肾上腺嗜铬细胞瘤切除术

 【目的】探讨两种不同入路的腹腔镜肾上腺嗜铬细胞瘤切除术。【方法】本组25例,男性14例,女性11例,平均53.3岁。左侧15例,右侧10例。术前均用苯苄胺等药物准备2～4周。经腹腔入路施行腹腔镜肾上腺嗜铬细胞瘤切除术11例,经腹膜后入路14例。在手术刚开始、建立气腹后、分离肿瘤时、切除肿瘤后分别记录心率、平均动脉压、中心静脉压的变化。【结果】1例早期经腹腔入路手术的病例在术中发现肿瘤粘连紧密改为开放性手术,其余24例在腹腔镜下顺利切除肿瘤。术后病理检查证实均为肾上腺嗜铬细胞瘤。术中脉搏血压没有剧烈波动。术后血压稳定,疼痛较轻,术后5～7d出院。经腹腔入路组与经腹膜后入路组在手术中心率、平均动脉压、中心静脉压以及手术时间和出血量等方面均没有显著差异(P>0.05)。无气胸、腹腔内脏器损伤、肠粘连等并发症。【结论】两种不同的入路施行腹腔镜肾上腺嗜铬细胞瘤切除术都是安全可行,具有操作精细、创伤小、恢复快等优点。

Transperitoneal and Retroperitoneal Laparoscopic Surgery for Adrenal Pheochromocytoma

Objective]To evaluate the laparoscopic surgery for adrenal pheochromocytoma by transperitoneal or retroperitoneal approaches. Methods] We performed a total of 25 laparoscopic adrenalectomy for adrenal pheochromocytoma, in 14 men and 11 women 29 to 78 years old (mean age 53). The masses located in the left lateral in 15 cases, and in the right lateral in 10 cases. All patients were given phenoxybenzamine for two to four weeks preoperatively. The operations were performed under general anesthesia via transperitoneal approach in 11 cases and via retroperitoneal approach in the other 14 ones. The intraoperative hemodynamic data was measured at the beginning of operation, after insufflation, just time for tumor separation and post operation. Results]Laparoscopic procedures were completed in 24 cases. Only one case of the transperitoneal group was transfered to open surgery for severe adherence. The pathological diagnosis of the specimen was adrenal pheochromocytoma in all the patients. During the operations, no severe fluctuation of blood pressure was observed. The patients were all uneventful and discharged five to seven days postoperatively. There were no significant differences of heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) between the transperitoneal group and the retroperitoneal group. And no difference of mean operating time and mean blood loss between the two groups were found (P >0.05). No pneumothorax or viscera injury was complicated.Conclusions]Both the transperitoneal and retroperitoneal laparoscopic approaches are feasible and safe for pheochromocytoma with the advantages of minimal invasion.