Song Gang, Zhou Li-Qun, Cai Lin
Department of Urology, First Hospital, Institute of Urology, Peking University, Beijing 100034, China.
Zhonghua Wai Ke Za Zhi. 2008 Aug 15;46(16):1245-8.
To investigate the safety of laparoscopic adrenalectomy for adrenal pheochromocytoma with maximum diameter of 5 - 10 cm.
Retrospective analysis was performed for 79 consecutive patients who underwent adrenalectomy for adrenal pheochromocytoma between January 2001 and June 2007. Forty-one patients among these cases had tumors of maximum diameter of 5 - 10 cm. Nine patients who underwent laparoscopic procedures (the additional 2 cases were converted to open surgery and were excluded) were compared with 30 patients who underwent open procedures using two-tailed unpaired t tests or Mann-Whitney U tests.
There was no significant difference in age, maximum diameter of tumor, the highest preoperative systolic/diastolic pressure, the preoperative heart rate and the plasma catecholamines between the two groups (P > 0.05). All laparoscopic procedures were performed by retroperitoneal approach. For open surgeries, 11 were performed by transperitoneal approach and 19 by retroperitoneal approach. We found significant differences between laparoscopic and open groups in the operative time, the blood loss, and postoperative hospital stay. Blood-transfusion was not required in the laparoscopic group and the median volume of blood-transfusion in the open group was 225 ml (0 - 3800 ml). No significant differences were found in intraoperative maximum and minimum blood pressures, maximum and minimum heart rates, systolic blood pressure increased by 30% from the preoperative baseline, systolic blood pressure > or = 200 mm Hg (1 mm Hg = 0.133 kPa), systolic blood pressure < or = 90 mm Hg, incidence of tachycardia (> or = 110 bpm) and bradycardia (< or = 50 bpm) (P > 0.05). And the drainage volume, drainage time, duration in ICU, time to first oral intake and cost of hospitalization were not significantly different between the two groups (P > 0.05).
For adrenal pheochromocytoma with maximum diameter of 5 - 10 cm, the laparoscopic procedure decreased operative time, blood loss, blood-transfusion and postoperative hospital stay compared to traditional open surgery. Intraoperative hemodynamic values during laparoscopic adrenalectomy are comparable to those of traditional open surgery. Adrenal pheochromocytoma of 5 - 10 cm is not a contraindication of laparoscopic surgery and experienced urologists can perform it safely for large adrenal pheochromocytoma.
探讨腹腔镜肾上腺切除术治疗最大直径为5 - 10 cm的肾上腺嗜铬细胞瘤的安全性。
对2001年1月至2007年6月期间连续79例行肾上腺嗜铬细胞瘤肾上腺切除术的患者进行回顾性分析。其中41例患者肿瘤最大直径为5 - 10 cm。将9例行腹腔镜手术的患者（另外2例中转开腹手术，予以排除）与30例行开放手术的患者采用两独立样本t检验或Mann-Whitney U检验进行比较。
两组患者在年龄、肿瘤最大直径、术前最高收缩压/舒张压、术前心率及血浆儿茶酚胺水平方面差异均无统计学意义（P > 0.05）。所有腹腔镜手术均采用后腹腔途径。开放手术中，11例采用经腹腔途径，19例采用后腹腔途径。我们发现腹腔镜组与开放手术组在手术时间、术中出血量及术后住院时间方面存在显著差异。腹腔镜组无需输血，开放手术组术中输血中位数为225 ml（0 - 3800 ml）。两组患者术中最高和最低血压、最高和最低心率、收缩压较术前基线升高30%、收缩压≥200 mmHg（1 mmHg = 0.133 kPa）、收缩压≤90 mmHg、心动过速（≥110次/分）及心动过缓（≤50次/分）发生率比较，差异均无统计学意义（P > 0.05）。两组患者的引流量及引流时间、ICU停留时间、首次进食时间及住院费用比较，差异均无统计学意义（P > 0.05）。
对于最大直径为5 - 10 cm的肾上腺嗜铬细胞瘤，与传统开放手术相比，腹腔镜手术可缩短手术时间、减少术中出血量、避免输血及缩短术后住院时间。腹腔镜肾上腺切除术术中血流动力学指标与传统开放手术相当。5 - 10 cm的肾上腺嗜铬细胞瘤并非腹腔镜手术的禁忌证，经验丰富的泌尿外科医生可安全地对较大的肾上腺嗜铬细胞瘤实施手术。
