Irvin G L, Fishman L M, Sher J A, Yeung L K, Irani H
Department of Surgery, University of Miami School of Medicine, Florida 33101.
Ann Surg. 1989 Jun;209(6):774-8. doi: 10.1097/00000658-198906000-00015.
The possibility of bilateral, extra-adrenal, and malignant tumors has dictated a thorough abdominal exploration through an anterior incision in the management of patients with pheochromocytomas. Careful visualization or palpation of the sites known to harbor secondary tumors is still recommended by many surgeons. The present study contrasts the results and morbidity of the retroperitoneal approach with that of the intraperitoneal operative approach for resection of pheochromocytoma. In the last 14 years, 37 patients had successful total resections of their pheochromocytomas, excluding one patient with metastasis to the liver at the time of surgery who died 10 years after operation. After preoperative localization of their tumors, 17 patients were explored anteriorly and 20 underwent resection using a lateral approach. Thirty-one patients have been followed from 2 to 141 (average 56) months. All patients have either returned to a normotensive state on no medication (27 patients) or, while requiring medication (9 patients), have had normal urinary metanephrine/catecholamine levels, except for the one patient with metatastic disease. There were substantial differences in morbidity rates between the two groups, however. Four patients (20%) had minor postoperative complications, following retroperitoneal resection that included pleural effusion, urinary retention, pulmonary congestion, and fever. Nine patients (53%) had complications when the anterior approach was used, including splenectomy in two, pneumonia, and postoperative fever. Postoperative hospital stay averaged 9.8 days (range, 4 to 21 days) for the anterior group and 6.1 days (range, 4 to 12 days) when a lateral approach was used (p = 0.002). Our data suggest that, with accurate unilateral localization, the flank, retroperitoneal approach for resection of pheochromocytoma can be used successfully with less morbidity.
双侧、肾上腺外及恶性嗜铬细胞瘤的可能性决定了在处理嗜铬细胞瘤患者时需通过前入路进行全面的腹部探查。许多外科医生仍建议仔细观察或触诊已知存在继发性肿瘤的部位。本研究对比了腹膜后入路与经腹手术入路切除嗜铬细胞瘤的结果及发病率。在过去14年中，37例患者成功地完全切除了嗜铬细胞瘤，其中1例手术时已有肝转移的患者术后10年死亡。在对肿瘤进行术前定位后，17例患者采用前入路进行探查，20例采用侧入路进行切除。31例患者随访了2至141个月（平均56个月）。除1例有转移疾病的患者外，所有患者要么在未用药的情况下恢复到血压正常状态（27例患者），要么在需要用药（9例患者）时尿间甲肾上腺素/儿茶酚胺水平正常。然而，两组的发病率存在显著差异。腹膜后切除术后有4例患者（20%）出现轻微术后并发症，包括胸腔积液、尿潴留、肺淤血和发热。采用前入路时9例患者（53%）出现并发症，包括2例脾切除术、肺炎和术后发热。前入路组术后平均住院时间为9.8天（范围4至21天），侧入路组为6.1天（范围4至12天）（p = 0.002）。我们的数据表明，在准确单侧定位的情况下，经腰、腹膜后入路切除嗜铬细胞瘤可以成功实施，且发病率较低。
