Gotoh Momokazu, Ono Yoshinari, Hattori Ryohei, Kinukawa Tsuneo, Ohshima Shinichi
Department of Urology, Nagoya University School of Medicine, Nagoya, Japan.
J Endourol. 2002 May;16(4):245-9; discussion 249-50. doi: 10.1089/089277902753752223.
We report our experience with laparoscopic adrenalectomy in nine patients with pheochromocytoma and compare the morbidity with that of laparoscopic adrenalectomy for tumors of other pathology.
Between January 1997 and November 1999, nine patients underwent laparoscopic surgery for pheochromocytoma via a transperitoneal approach. Of the patients, eight had solitary tumors, and one presented with bilateral pheochromocytomas. The mean size of the tumors was 5.4 cm. The surgical outcomes of the 9 patients were compared with those of 28 patients with adrenal tumors of other pathology (primary aldosteronism in 15 patients, Cushing syndrome in 6, and nonfunctioning adenoma in 7) who underwent transperitoneal laparoscopic adrenalectomy during the same period. The mean size of the adrenal tumors of other pathology was 2.4 cm.
In eight of the nine patients with pheochromocytoma, laparoscopic adrenalectomy was successful. The procedure was converted to open surgery in the patient with bilateral tumors because of uncontrollable hemorrhage. A hypertensive crisis with the systolic blood pressure >200 mm Hg occurred in 6 patients (67%), but the episode could be controlled by temporary discontinuation of tumor manipulation, administration of drugs, or both. In adrenalectomy for pheochromocytoma, the mean operative time was longer (199 v 177 minutes) and the mean estimated blood loss was greater (360 v 54 mL) than for tumors of other pathology. Blood transfusion was given to two patients with pheochromocytoma but to no patient with tumors of other pathology. The patients with adrenal tumors of other pathology could resume normal activity earlier (mean 18 v 26 days) than those with pheochromocytoma.
The operation is more difficult and the morbidity is higher in laparoscopic adrenalectomy for pheochromocytoma than that for tumors of other pathology. An experienced team of surgeons with advanced laparoscopic skills and anesthesiologists is mandatory. In large tumors, great caution should be taken for intraoperative complications. Nevertheless, laparoscopic adrenalectomy is not contraindicated for pheochromocytoma and can be performed safely.
我们报告9例嗜铬细胞瘤患者行腹腔镜肾上腺切除术的经验，并将其发病率与其他病理类型肿瘤行腹腔镜肾上腺切除术的发病率进行比较。
1997年1月至1999年11月，9例患者经腹膜途径行腹腔镜嗜铬细胞瘤切除术。其中，8例为单发肿瘤，1例为双侧嗜铬细胞瘤。肿瘤平均大小为5.4 cm。将这9例患者的手术结果与同期28例其他病理类型肾上腺肿瘤（15例原发性醛固酮增多症、6例库欣综合征、7例无功能腺瘤）行腹膜后腹腔镜肾上腺切除术的结果进行比较。其他病理类型肾上腺肿瘤的平均大小为2.4 cm。
9例嗜铬细胞瘤患者中，8例腹腔镜肾上腺切除术成功。双侧肿瘤患者因出血难以控制而转为开放手术。6例患者（67%）发生收缩压>200 mmHg的高血压危象，但通过暂时停止肿瘤操作、使用药物或两者并用可控制发作。嗜铬细胞瘤肾上腺切除术的平均手术时间较长（199分钟对177分钟），平均估计失血量较多（360 ml对54 ml），高于其他病理类型肿瘤。2例嗜铬细胞瘤患者输血，而其他病理类型肿瘤患者均未输血。其他病理类型肾上腺肿瘤患者比嗜铬细胞瘤患者更早恢复正常活动（平均18天对26天）。
嗜铬细胞瘤腹腔镜肾上腺切除术比其他病理类型肿瘤的手术难度更大，发病率更高。必须有经验丰富、具备先进腹腔镜技术的外科医生团队和麻醉医生。对于大肿瘤，应高度警惕术中并发症。尽管如此，腹腔镜肾上腺切除术并非嗜铬细胞瘤的禁忌证，可安全进行。
