摘要
目的评价后腹腔镜肾上腺嗜铬细胞瘤切除术的手术方法及临床效果。方法2006年3月-2008年6月对78例患者实施后腹腔镜嗜铬细胞瘤切除术。常规制备后腹腔操作空间。按顺序分别进入3个相对无血管解剖层面进行分离。第一分离层面位于腰肌前间隙;第二分离层面位于肾上极Gerota筋膜与肾周脂肪之间;第三分离层面位于肾上腺底部脂肪囊与肾上极实质之间。切除肿瘤及部分肾上腺。结果全部患者手术均顺利完成,手术时间145±53min,术中血压骤升49例(瞬间血压升高幅度≥50mmHg),术中出血100±49ml,术后哌替啶用量57±38mg,术后排气、恢复进食时间1.6±0.5d,术后恢复下床活动用时1.5±0.3d,术后住院时间5.8±1.9d。无输血及中转开放病例,无严重并发症发生。其中56例获得随访,随访12.3±8.7(2～26)个月,均未见复发及转移病灶。结论腹腔镜手术具有术野清晰,操作空间大,解剖标志明显,对肿瘤刺激小等特点。在充分的术前准备条件下,技术娴熟的泌尿外科医师实施后腹腔镜解剖性肾上腺嗜铬细胞瘤(直径≤6cm)
Objective To evaluate the technique and clinical effect of retroperitoneoscopic adrenalectomy for pheochromocytoma. Methods A total of 78 patients received roperitoneoscopic adrenalectomy for pheochromocytorna from March 2006 to June 2008. Retroperitoneal space was enlarged routinely with patient in lateral decubitus position. After adequate retroperitoneal space was created, three relatively bloodless planes were orderly entered for exposure and separation of the adrenal gland and tumor. The first dissection plane was between the psoas and posterior Gerota＇s fascia. The subsequent dissections were proceeded in the plane between anterior Gerota＇s fascia and perirenal fat. The third dissection plane was between the adrenal gland and upper pole of kidney. The tumor and parts of adrenal glands were then excised. Results All operations were successful. The mean operative time and estimated blood loss were 145±53min and 100±49 ml, with no blood transfusion, and no conversion to open surgery. The mean postoperative analgesic （pethidine） consumption was 57±38mg. Time for oral intake of food and ambulation after operation were 1.6±0.5d and 1.5±0.3d, respectively. The mean postoperative hospital stay was 5.8±1.9d. No major intraoperative complications occurred. Conspicuous fluctuation of blood pressure （≥50mmHg） was observed in 49 patients during operation. 56 patients were followed up, and no recurrence or metastasis of the tumor was found during a follow-up period of 12.3±8.7 months in average （range from 2 to 26 months）. Conclusions With adequate preparations, retroperitoneoscopic adrenalectomy for pheochromocytoma （≤6cm） is a safe and effective procedure in the hand of an exparienced surgeon since it gives a clear operative field, adequate space for manipulation, distinct anatomic landmark and minimal agitation.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2008年第12期1485-1487,共3页
Medical Journal of Chinese People's Liberation Army
基金
总后勤部卫生部科技攻关计划资助项目(06MA228)
陕西省科技攻关计划资助项目[2005K12-G4(1)]
