Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, 45136, Essen, Germany.
Langenbecks Arch Surg. 2012 Feb;397(2):233-8. doi: 10.1007/s00423-011-0851-2. Epub 2011 Sep 21.
Cortical-sparing adrenalectomy in bilateral pheochromocytomas offers a postoperative corticoid-free course and has to be balanced against the risk of local recurrence. In this study we report our experience with the minimally invasive cortical-sparing adrenalectomy in patients with bilateral pheochromocytomas.
From January 1996 to February 2011, 66 patients (45 men, 21 women; mean age 36 ± 16 years) were treated for bilateral pheochromocytomas. Fifty-seven patients (88%) were affected by genetic diseases. In 32 patients surgery was synchronously performed on both side, in 34 cases adrenalectomy followed previous surgery. All in all, 101 operations (47 right, 54 left) were conducted using the retroperitoneoscopic access (n = 97) or the laparoscopic route (n = 4).
The mortality in our series was zero. Postoperative complications included one patient with a bleeding requiring reoperation and one patient developing a cerebral stroke on the fifth postoperative day. The mean operative time was 67 ± 26 min for unilateral adrenalectomy and 128 ± 68 min for bilateral surgery (range 25-300 min). A cortical-sparing resection was possible in 89 procedures resulting in a corticoid-free postoperative course in 60 patients (91%). A postoperative corticosteroid substitution therapy was necessary in six patients. During a median follow-up period of 48 months, one patient showed a persistent disease and needed reoperation, none developed a recurrent disease.
Cortical-sparing surgery for bilateral pheochromocytomas has a low recurrence rate and avoids lifelong cortisone substitution therapy in the majority of cases.
在双侧嗜铬细胞瘤中进行皮质保留肾上腺切除术可提供无皮质激素的术后过程，但需要平衡局部复发的风险。本研究报告了我们在双侧嗜铬细胞瘤患者中采用微创性皮质保留肾上腺切除术的经验。
从 1996 年 1 月至 2011 年 2 月，共有 66 例（45 名男性，21 名女性；平均年龄 36±16 岁）双侧嗜铬细胞瘤患者接受了治疗。57 例（88%）患者患有遗传疾病。32 例患者同期行双侧手术，34 例患者先进行肾上腺切除术。总共，101 例手术（47 例右侧，54 例左侧）采用经腹膜后腹腔镜（n=97）或腹腔镜（n=4）途径进行。
在我们的系列中，死亡率为零。术后并发症包括一例需要再次手术的出血患者和一例术后第五天发生脑中风的患者。单侧肾上腺切除术的平均手术时间为 67±26 分钟，双侧手术的平均手术时间为 128±68 分钟（范围 25-300 分钟）。89 例手术中可进行皮质保留切除，60 例患者（91%）术后无需皮质激素替代治疗。6 例患者需要术后皮质激素替代治疗。在中位数为 48 个月的随访期间，1 例患者出现持续性疾病并需要再次手术，无患者出现疾病复发。
双侧嗜铬细胞瘤的皮质保留手术具有较低的复发率，并且在大多数情况下可避免终身皮质激素替代治疗。
