Flávio Rocha Marcos, Faramarzi-Roques Rozbeh, Tauzin-Fin Patrick, Vallee Vincent, Leitao de Vasconcelos Paulo R, Ballanger Philippe
Department of Urology, Hôpital Pellegrin-Tondu, Centre Hospitalier Universitaire Pellegrin, 5 place Amélie Raba-Léon, 33076 Cedex, Bordeaux, France.
Eur Urol. 2004 Feb;45(2):226-32. doi: 10.1016/j.eururo.2003.09.016.
To evaluate the feasibility of laparoscopic adrenalectomy for pheochromocytoma.
Between January 1998 and March 2002, 12 patients aged from 19 to 76 (average age 54 years) underwent 13 adrenalectomies (7 right and 6 left, 1 bilateral) using laparoscopic surgery. A specific anti-hypertensive preparation was begun prior to the operation. Peaks of blood pressure were treated by bolus Nicardipine and sinus tachycardia by bolus Esmolol. Catecholamines were dosed at different times during the intervention. As far as surgery was concerned, the adrenalectomies were performed 11 times using the transperitoneal route and twice using the retroperitoneal route. The adrenal vein was found and ligatured before manipulation of the adrenal gland.
Average length of operation was 127 minutes (75 to 195). Average blood loss was 105 ml (0 to 1000). Catecholamines dosed throughout showed a variable increase in plasma rates during peritoneal insufflation and manipulation of the gland. They were responsible for 5 cases of hypertensive bouts and 2 cases of tachycardia which were treated with medication. No surgical conversions were necessary. Average length of hospital stay was 4.18 days (3 to 6); average size of adrenal tumours was 44 mm (30 to 72); average follow-up, 18.4 months.
This study showed the feasibility of adrenalectomy for pheochromocytoma using laparoscopic surgery, subject to specific medical preparation to reduce the consequences of peroperative bouts of hypertension and sinus tachycardia during peritoneal insufflation and manipulation of the adrenal gland despite initial ligature of the main adrenal vein.
评估腹腔镜肾上腺切除术治疗嗜铬细胞瘤的可行性。
1998年1月至2002年3月期间，12例年龄在19至76岁（平均年龄54岁）的患者接受了13次肾上腺切除术（右侧7例，左侧6例，双侧1例），采用腹腔镜手术。术前开始使用特定的抗高血压制剂。血压峰值通过静脉推注尼卡地平治疗，窦性心动过速通过静脉推注艾司洛尔治疗。在干预过程中的不同时间点测定儿茶酚胺。就手术而言，11次肾上腺切除术采用经腹途径，2次采用腹膜后途径。在处理肾上腺之前找到并结扎肾上腺静脉。
平均手术时间为127分钟（75至195分钟）。平均失血量为105毫升（0至1000毫升）。在整个手术过程中测定的儿茶酚胺显示，在气腹和肾上腺操作期间血浆水平有不同程度的升高。它们导致了5例高血压发作和2例心动过速，经药物治疗。无需进行手术中转。平均住院时间为4.18天（3至6天）；肾上腺肿瘤平均大小为44毫米（30至72毫米）；平均随访时间为18.4个月。
本研究表明，尽管最初结扎了主要肾上腺静脉，但在进行特定的医学准备以减少气腹和肾上腺操作期间术中高血压发作和窦性心动过速的后果的情况下，腹腔镜手术治疗嗜铬细胞瘤所致肾上腺切除术是可行的。
