Wang Jiaji, Li Yi, Xiao Nan, Duan Jianmin, Yang Ninqiang, Bao Junsheng, Li Ye, Mi Jun
1 The Second Urological Department, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University , Lanzhou, China .
J Endourol. 2014 Nov;28(11):1345-51. doi: 10.1089/end.2014.0345. Epub 2014 Jul 31.
Paraganglioma (PG) is a rare neuroendocrine entity. Surgical resection is recommended as the mainstay of treatment due to the uncontrolled hypertension, close proximity to major vessels, variable location, and higher potential malignancy. With rapid development of minimally invasive techniques during the past decade, laparoscopic resection of retroperitoneal PG has been reported with successful results. There are only a few publications describing retroperitoneal access, however. In the present study, we proposed to summarize our experience on retroperitoneal laparoscopic resection in 10 patients and systematically review relevant publications to evaluate its safety and efficacy.
From June 2009 to October 2013, 10 patients with PG who were treated with retroperitoneoscopy were included in the study. Minimal effective dosage α-blockade with phenoxybenzamine was routinely used. Preoperative, intraoperative, and postoperative baseline data were collected and analyzed. Meanwhile, two reviewers independently searched and identified 8 retrospective studies and 23 case reports in the Medline, Embase, and Science Citation Index between 1998 and 2013.
Operations in 9 of 10 patients were successfully completed without conversion; one case was converted to open surgery because of left accessory renal artery injury. Mean operative time, blood loss, and postoperative hospital stay were 97.8±20.6 minutes, 44.4±8.2 mL, and 4.8±3.5 days, respectively. There were three complications in this series, including accessory renal artery injury, renal vein injury, and chylorrhea.
Retroperitoneoscopic resection is feasible, effective, and safe in the treatment of patients with PG according to our preliminary clinical experience and has distinct advantages including direct access to the tumor, less intraperitoneal interference, precise dissection, and minimal invasiveness.
副神经节瘤（PG）是一种罕见的神经内分泌肿瘤。由于其可导致难以控制的高血压、与主要血管距离近、位置多变以及较高的潜在恶性程度，手术切除被推荐为主要治疗方法。在过去十年中，随着微创技术的快速发展，已有腹腔镜切除腹膜后PG取得成功的报道。然而，仅有少数文献描述了腹膜后入路。在本研究中，我们总结了10例患者行腹膜后腹腔镜切除术的经验，并系统回顾相关文献以评估其安全性和有效性。
2009年6月至2013年10月，纳入10例行腹膜后腔镜手术治疗的PG患者。常规使用苯苄胺进行最小有效剂量的α受体阻滞。收集并分析术前、术中和术后的基线数据。同时，两名研究者独立检索并确定了1998年至2013年间发表在Medline、Embase和科学引文索引中的8项回顾性研究和23例病例报告。
10例患者中有9例手术成功完成，未中转；1例因左副肾动脉损伤中转开腹手术。平均手术时间、出血量和术后住院时间分别为97.8±20.6分钟、44.4±8.2毫升和4.8±3.5天。本系列中有3例并发症，包括副肾动脉损伤、肾静脉损伤和乳糜漏。
根据我们的初步临床经验，腹膜后腔镜切除术治疗PG患者是可行且安全有效的，具有直接暴露肿瘤、减少腹腔内干扰、解剖精确和微创等明显优势。
