Department of Surgery, Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 S Euclid Ave., Box 8109, St. Louis, MO 63110, USA.
Surg Endosc. 2013 Feb;27(2):428-33. doi: 10.1007/s00464-012-2451-9. Epub 2012 Aug 31.
Laparoscopic adrenalectomy (LA) is the standard for removal of adrenal pheochromocytomas (pheos), but laparoscopic (LAP) resection of paragangliomas (PGs) is controversial. This study analyzes our results of resection of PGs in the LAP era.
A retrospective record review of all patients who underwent resection of intra-abdominal PGs from 1998 to 2011 was performed. Pre- and postoperative clinical, radiologic, biochemical, and pathologic data for LAP resection of PGs were compared with patients who underwent LA for adrenal pheo (LA pheo; n = 62). Statistical analysis was performed and data are reported as mean ± SD.
Fifteen patients had resection of PGs (6 OPEN, 9 LAP) and 62 had LA pheo. Most common PG locations were perirenal or renal hilum (n = 6) and para-aortic (n = 4). One LAP PG was converted to OPEN due to inflammation from a prior biopsy. Mean age of LAP PGs was 45.3 ± 13.2 years, and mean tumor size was 3.3 ± 2.1 cm. OPEN PGs were larger (5.1 vs. 3.3 cm), had shorter operative times (173 vs. 254 min), and longer hospitalization (5.7 vs. 2.6 days) and ICU stays (1.33 vs. 0.22 days) compared with LAP PGs (p ≤ 0.05). Compared with LA pheo, operative times for LAP PG were significantly longer (254 vs. 175 min, p = 0.001) but other outcomes were similar. Complications occurred in 5.9 % of LA pheos, 22 % of LAP PGs and 67 % of OPEN PGs.
Patients with paragangliomas can safely benefit from LAP resection with outcomes similar to adrenal pheos. In the absence of a need for contiguous organ resection, LAP resection of paragangliomas seems to be the preferred surgical approach.
腹腔镜肾上腺切除术（LA）是切除肾上腺嗜铬细胞瘤（pheos）的标准方法，但腹腔镜（LAP）切除副神经节瘤（PGs）存在争议。本研究分析了我们在 LAP 时代切除 PGs 的结果。
对 1998 年至 2011 年间接受腹腔内 PGs 切除的所有患者进行回顾性记录回顾。比较了 LAP 切除 PGs 的术前、术后临床、影像学、生化和病理数据与接受 LA 切除肾上腺 pheo（LA pheo；n=62）的患者。进行了统计学分析，数据以平均值±标准差表示。
15 例患者行 PGs 切除术（6 例开放，9 例 LAP），62 例患者行 LA pheo。最常见的 PG 位置是肾旁或肾门（n=6）和主动脉旁（n=4）。1 例 LAP PG 因先前活检引起的炎症而转为开放。LAP PG 的平均年龄为 45.3±13.2 岁，平均肿瘤大小为 3.3±2.1cm。OPEN PG 较大（5.1 比 3.3cm），手术时间较短（173 比 254min），住院时间（5.7 比 2.6 天）和 ICU 停留时间（1.33 比 0.22 天）较长（p≤0.05）。与 LA pheo 相比，LAP PG 的手术时间明显延长（254 比 175min，p=0.001），但其他结果相似。LA pheo 并发症发生率为 5.9%，LAP PG 为 22%，OPEN PG 为 67%。
患有副神经节瘤的患者可以安全地从 LAP 切除中受益，其结果与肾上腺 pheo 相似。在不需要连续器官切除的情况下，LAP 切除副神经节瘤似乎是首选的手术方法。
