de Lagausie P, Berrebi D, Michon J, Philippe-Chomette P, El Ghoneimi A, Garel C, Brisse H, Peuchmaur M, Aigrain Y
Department of Pediatric Surgery, Hôpital Robert Debré, AP-HOP Paris, 48 boulevard Serurier, 75019 Paris, France.
J Urol. 2003 Sep;170(3):932-5. doi: 10.1097/01.ju.0000081415.49550.01.
The role of laparoscopy in children with neuroblastomas has not been fully defined. The laparoscopic approach to the adrenal gland is already largely used in adults and a few cases have been reported in children. We report the experience of a single surgical team center with laparoscopic adrenal surgery for neuroblastomas in children.
Between September 2000 and October 2002 laparoscopic adrenalectomy for neuroblastoma was performed in 9 patients (6 girls and 3 boys) with a mean age of 38 months (range 2 months to 9 years). Two tumors were detected prenatally and 7 postnatally. Preoperative diagnosis was neuroblastoma stage I in 4 cases and stage IV in 3 cases, and nondetermined suprarenal calcified masses in 2 cases. A 4 or 5-trocar transperitoneal approach was used in all cases. The adrenal tumors were completely excised, placed into a plastic bag and removed through the umbilical trocar site.
All of the adrenal tumors were well encapsulated and completely excised. One of the 9 procedures was converted to open surgery because of adhesions to renal vessels. In 1 case a second hepatic localization was removed simultaneously, and in 3 cases 1 or more lymph nodes were resected. Average operative time was 85 minutes (range 45 to 170). There were no deaths. There were no postoperative complications, except 1 port site infection that was treated locally. Blood transfusion was not required. Average hospital stay was 4.5 days (range 2 to 10). Histological analysis of the 9 specimens (maximum length 6 cm) confirmed the diagnosis of neuroblastoma. N-myc status was studied in 8 of the 9 resected neuroblastomas and was amplified in 2 cases (both stage IV with preoperative biopsy). Average postoperative followup was 15 months (range 1 to 25). There was no local recurrence or metastasis, except in the case that required conversion to open surgery (local recurrence 7 months later).
Laparoscopic adrenalectomy for neuroblastoma is safe and feasible in children, with good results. Experience with advanced laparoscopic surgery is required to achieve this result in optimal oncological conditions. Our short-term results must be reevaluated at long term, and further studies are needed to compare laparoscopy to open surgical techniques.
腹腔镜检查在神经母细胞瘤患儿中的作用尚未完全明确。腹腔镜肾上腺手术方法在成人中已广泛应用，儿童中的病例报道较少。我们报道了一个单一手术团队中心在儿童神经母细胞瘤腹腔镜肾上腺手术方面的经验。
2000年9月至2002年10月，对9例神经母细胞瘤患儿（6例女孩，3例男孩）实施了腹腔镜肾上腺切除术，平均年龄38个月（范围2个月至9岁）。2例肿瘤产前发现，7例产后发现。术前诊断为神经母细胞瘤I期4例，IV期3例，2例为未明确的肾上腺钙化肿块。所有病例均采用4或5孔经腹入路。肾上腺肿瘤均完整切除，装入塑料袋后经脐部穿刺孔取出。
所有肾上腺肿瘤均包膜完整，完整切除。9例手术中有1例因与肾血管粘连而转为开放手术。1例同时切除了肝脏的第二个病灶，3例切除了1个或多个淋巴结。平均手术时间为85分钟（范围45至170分钟）。无死亡病例。除1例穿刺孔局部感染经局部处理外，无术后并发症。无需输血。平均住院时间为4.5天（范围2至10天）。9个标本（最大长度6厘米）的组织学分析确诊为神经母细胞瘤。9例切除的神经母细胞瘤中有8例研究了N - myc状态，2例（均为术前活检为IV期）呈扩增状态。平均术后随访15个月（范围1至25个月）。除转为开放手术的病例（7个月后局部复发）外，无局部复发或转移。
儿童神经母细胞瘤腹腔镜肾上腺切除术安全可行，效果良好。要在最佳肿瘤学条件下取得这一结果，需要有先进腹腔镜手术的经验。我们的短期结果必须长期重新评估，还需要进一步研究以比较腹腔镜手术与开放手术技术。
