Zhang Xu, Lang Bin, Ouyang Jin-Zhi, Fu Bin, Zhang Jun, Xu Kai, Wang Bao-Jun, Ma Xin
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Urology. 2007 May;69(5):849-53. doi: 10.1016/j.urology.2007.01.078.
To evaluate the effectiveness and safety of retroperitoneal laparoscopic adrenalectomy for pheochromocytoma and report our experience in adrenalectomy without previous control of the adrenal vein.
From January 2000 to December 2005, 56 patients underwent 58 retroperitoneal laparoscopic adrenalectomy procedures for the treatment of pheochromocytoma. Adequate preoperative antihypertensive preparation was performed. Intraoperative hemodynamic changes were documented in detail. During surgery, the adrenal vein was identified and ligated after dissection and mobilization of the adrenal gland.
One patient required conversion to open surgery. The mean operative time and estimated blood loss was 50.4 +/- 19.8 minutes (range 25 to 150) and 76.4 +/- 23.5 mL (range 20 to 300), respectively. A systolic blood pressure greater than 200 mm Hg or less than 80 mm Hg was observed in 6 and 3 patients, respectively. Moreover, an upward fluctuation of systolic blood pressure (20 mm Hg or greater) was recorded during laparoscopic manipulation in 21 patients (37.5%), and in 8 of them, it was 50 mm Hg or greater. The mean diameter of the excised masses was 4.6 +/- 1.7 cm (range 1.5 to 10.0). The mean hospital stay was 5.2 +/- 1.3 days (range 3 to 9). No patients had a major complication and none died. During the follow-up period of 5 months to 3 years, 36 patients recovered normal blood pressure without antihypertensive drugs. No tumor recurrences developed.
Retroperitoneal laparoscopic adrenalectomy without previous control of the adrenal vein is effective and safe for ablation of pheochromocytoma. For experienced surgeons, the tumors larger than 6 cm in diameter can also be removed using the retroperitoneal endoscopic approach.
评估后腹腔镜肾上腺切除术治疗嗜铬细胞瘤的有效性和安全性，并报告我们在未预先控制肾上腺静脉情况下进行肾上腺切除术的经验。
2000年1月至2005年12月，56例患者接受了58次后腹腔镜肾上腺切除术以治疗嗜铬细胞瘤。进行了充分的术前降压准备。详细记录术中血流动力学变化。手术过程中，在肾上腺解剖和游离后识别并结扎肾上腺静脉。
1例患者需要转为开放手术。平均手术时间和估计失血量分别为50.4±19.8分钟（范围25至150分钟）和76.4±23.5毫升（范围20至300毫升）。分别有6例和3例患者观察到收缩压大于200 mmHg或小于80 mmHg。此外，21例患者（37.5%）在腹腔镜操作期间记录到收缩压向上波动（20 mmHg或更大），其中8例患者波动幅度为50 mmHg或更大。切除肿块的平均直径为4.6±1.7厘米（范围1.5至10.0厘米）。平均住院时间为5.2±1.3天（范围3至9天）。无患者发生严重并发症，无一例死亡。在5个月至3年的随访期内，36例患者在未使用降压药物的情况下恢复了正常血压。无肿瘤复发。
未预先控制肾上腺静脉的后腹腔镜肾上腺切除术对于切除嗜铬细胞瘤是有效且安全的。对于经验丰富的外科医生，直径大于6厘米的肿瘤也可采用后腹腔镜内镜方法切除。
