腹腔镜切除5～10 cm肾上腺嗜铬细胞瘤的安全性分析

目的 探讨5～10 cm肾上腺嗜铬细胞瘤腹腔镜切除术的安全性. 方法 2001年1月至2007年6月在北京大学第一医院泌尿外科行肾上腺嗜铬细胞瘤切除的连续79例患者中肿瘤最大径5～10 cm者共41例,回顾分析其临床资料.腹腔镜组11例(其中2例中转开放,数据分析时排除在外),开放手术组30例.应用t检验、Mann-Whitney U检验对两组患者的临床资料及围手术期数据进行分析. 结果 两组患者年龄、肿瘤最大径、术前最高收缩压及舒张压、术前心率、血儿茶酚胺水平的差异均无统计学意义(P>0.05).腹腔镜组均经腹膜后途径.开放手术组经腹腔途径11例,经腹膜后途径19例.两组患者手术时间分别为(132±54)min和(178±64)min;术中出血量分别为100 ml(0～800 m1)和450 ml(0～9500 ml);术后住院时间分别为(7±2)d和(9±4)d,差异均有统计学意义(P<0.05).腹腔镜组术中均未输血,开放手术组术中输血量的中位值为225 ml(0～3800 ml).2组患者术中最高血压、最低血压、最快心率、最慢心率、收缩压增加基础血压30%的次数、收缩压≥200 mm Hg(1 mm Hg=0.133 kPa)次数、收缩压≤90 mm Hg次数、心率≥110次/min次数、心率≤50次/min次数的差异均无统计学意义(P>0.05).两组患者引流量、拔管时间、住ICU时间、术后开始进食时间、住院费用差异均无统计学意义(P>0.05). 结论 腹腔镜切除5～10 cm肾上腺嗜铬细胞瘤的手术时间、术中出血量、术中输血量、术后住院日较开放手术有优势,且术中血压、心率波动等指标不高于开放手术.因此,5～10 cm的肾上腺嗜铬细胞瘤不是腹腔镜的绝对禁忌,经验丰富的术者可以考虑开展腹腔镜手术切除较大肾上腺嗜铬细胞瘤.

Safety analysis of laparoscopic adrenalectomy for adrenal pheochromocytoma of 5 to 10 cm

Objective To investigate the safety of laparoseopic adrenalectomy for adrenal pheochromocytoma with maximum diameter of 5-10 cm. Methods Retrospective analysis was performed for 79 consecutive patients who underwent adrenalectomy for adrenal pheochromocytoma between January 2001 and June 2007. Forty-one patients among these cases had tumors of maximum diameter of 5-10 cm. Nine patients who underwent laparoscopic procedures (the additional 2 cases were converted to open surgery and were excluded) were compared with 30 patients who underwent open procedures using two-tailed unpaired t tests or Mann-Whitney U tests. Results There was no significant difference in age, maximum diameter of tumor, the highest preoperative systolic/diastolic pressure, the preoperative heart rate and the plasma catecholamines between the two groups (P > 0. 05 ). All laparoscopic procedures were performed by retroperitoneal approach. For open surgeries, 11 were performed by transperitoneal approach and 19 by retroperitoneal approach. We found significant differences between laparoscopic and open groups in the operative time, the blood loss, and postoperative hospital stay. Blood-transfusion was not required in the laparoscopic group and the median volume of bloed-transfusion in the open group was 225 ml (0-3800 ml). No significant differences were found in intraoperative maximum and minimum blood pressures, maximum and minimum heart rates, systolic blood pressure increased by 30% from the preoperative baseline, systolic blood pressure ≥200 mm Hg (1 mm Hg =0. 133 kPa),systolic blood pressure≤90 mm Hg, incidence of tachycardia( ≥ 110 bpm) and bradycardia( ≤ 50 bpm) (P > 0. 05 ). And the drainage volume, drainage time, duration in ICU, time to first oral intake and cost of hospitalization were not significantly different between the two groups( P > 0. 05 ). Conclusions For adrenal pheochromocytoma with maximum diameter of 5-10 cm, the laparoscopic procedure decreased operative time, blood loss, blood-transfusion and postoperative hospital stay compared to traditional open surgery. Intraoperative hemodynamic values during laparoscopic adrenalectomy are comparable to those of traditional open surgery. Adrenal pheochromocytoma of 5-10 cm is not a contraindication of laparoscopic surgery and experienced urologists can perform it safely for large adrenal pheochromocytoma.