摘要
目的:探讨经后腹腔联合经腹腔双入路腹腔镜技术治疗巨大嗜铬细胞瘤的可行性及安全性,总结初步疗效和临床技术经验。方法:回顾性分析2017年1月至2019年12月陆军军医大学第一附属医院收治的21例巨大嗜铬细胞瘤患者的临床资料,男12例,女9例。平均年龄(42.9±11.9)岁。体质指数(23.2±3.1)kg/m 2。术前收缩压150~220 mmHg(1 mmHg=0.133 kPa),舒张压80~160 mmHg。术前CT检查均提示嗜铬细胞瘤;肿瘤位于右侧12例,左侧9例;平均最大径(9.1±3.3)cm。术前21例均予甲磺酸多沙唑嗪充分控制血压。21例均全麻下行单一体位经后腹腔联合经腹腔双入路腹腔镜手术:患者取健侧折刀位,先经后腹腔充分游离肿瘤,然后纵向切开腹膜反折,于患侧锁骨中线与肋缘交点下2横指新建1个通道,联合经后腹腔操作通道转换行经腹腔手术。记录手术相关数据、术中循环监测数据、术后并发症及随访信息等。结果:本组21例手术均顺利完成,术中无肿瘤破裂,无中转开放手术。平均手术时间(166.7±32.8)min;估计失血量(205.4±45.3)ml,5例因术中失血量大输血治疗。术中9例发生循环不稳定;术后5例出现持续>24 h的低血压,予静脉泵入去甲肾上腺素恢复正常。未出现其他并发症。平均住院时间(6.5±1.7)d。病理检查均诊断为嗜铬细胞瘤。中位随访12(6~30)个月,21例血压均恢复正常,未见肿瘤复发。结论:双入路腹腔镜技术有利于术野显露,避免暴力牵拉或压迫瘤体,可降低术中循环不稳定及术后并发症发生率。该术式安全可行,为治疗巨大嗜铬细胞瘤提供了一种新的手术方案。
Objective To discuss the feasibility and safety of dual combined retroperitoneal and transperitoneal laparoscopic approach for large pheochromocytoma.Methods The clinical characteristics of 21 patients with large pheochromocytoma were retrospectively analyzed(January 2017 to December 2019).The average age of the patients was(42.9±11.9)years old.The body mass index(BMI)was(23.2±3.1)kg/m2.The blood pressure of the patients increased to varying degrees[systolic blood pressure 150-220 mmHg(1 mmHg=0.133 kPa),diastolic blood pressure 80-160 mmHg].Preoperative CT showed pheochromocytoma in 12 cases on the right side and 9 cases on the left side with an average maximum diameter of(9.1±3.3)cm.Before operation,Doxazosin Mesylate was given orally to fully control the blood pressure.The single position dual combined retroperitoneal and transperitoneal laparoscopic adrenalectomy was performed.The patient took the contralateral folding knife position,fully free the tumor through the retroperitoneal pathway,and then cut the peritoneal retroflexion longitudinally.The operation was converted to transperitoneal pathway through the trocars of retroperitoneal pathway with a new channel built in 2 fingers below the intersection of the midline of clavicle and costal margin.The operation related data,intraoperative hemodynamic state,postoperative complications and follow-up information were collected and analyzed.Results The operation was successful in all of the 21 patients without tumor rupture and conversion to open surgery.The average operation time was(166.7±32.8)min and the estimated blood loss was(205.4±45.3)ml.5 patients were treated with blood transfusion.The incidence of intraoperative hemodynamic instability was 42.9%(9/21).5 patients had prolonged hypotension more than 24 hours,and the blood pressure returned to normal with norepinephrine pumped.The mean length of stay was(6.5±1.7)days.All patients were pathologically confirmed as pheochromocytoma.Blood pressure returned to normal,and no recurrence was found with a me
作者
周晓洲
何鹏
李珍燕
刘洋
陈志朋
宋思吉
王永权
Zhou Xiaozhou;He Peng;Li Zhenyan;Liu Yang;Chen Zhipeng;Song Siji;Wang Yongquan(Urology Institute of People Liberation Army,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第12期887-891,共5页
Chinese Journal of Urology
基金
陆军军医大学临床医学科研人才培养计划(2018XLC3006)。
关键词
嗜铬细胞瘤
腹腔镜手术
经后腹腔途径
经腹腔途径
术中循环不稳定
Pheochromocytoma
Laparoscopic surgery
Retroperitoneal approach
Transperitoneal approach
Intraoperative hemodynamic instability
