Meurisse M, Joris J, Hamoir E, Hubert B, Charlier C
Section of Endocrine Surgery, Centre Hospitalier Universitaire du Sart-Tilman, Université de Liège, Belgium.
Surg Endosc. 1995 Apr;9(4):431-6. doi: 10.1007/BF00187168.
Until now, the need for wide exposure and nonmanipulative dissection of pheochromocytoma has dictated the use of a large intraperitoneal transabdominal approach, which unfortunately results in a significant incidence of morbidity. A unilateral retroperitoneal approach guided by the refinements of new imaging techniques is less invasive but is associated with a small risk of incomplete cure. In one case report, we tested the hypothesis that laparoscopic surgery could combine the beneficial effects of both operative strategies without their respective side effects. We concluded that a laparoscopic approach combined with exclusive intraoperative infusion of nicardipine, a calcium-channel blocker, can be used to surgically remove pheochromocytoma under stable hemodynamic conditions. This provides better exposure of the anatomical structures than open surgery and allows a visual exploration of the entire abdominal cavity to exclude tumor multicentricity or ectopic sites in the case of inconclusive preoperative imaging investigations. Moreover, conversion to open surgery is always possible if needed.
到目前为止，由于需要广泛暴露和非操作性解剖嗜铬细胞瘤，一直采用大型经腹腔入路，不幸的是，这导致了较高的发病率。在新的成像技术改进的指导下，采用单侧腹膜后入路侵入性较小，但存在治愈不完全的小风险。在一份病例报告中，我们检验了这样一种假设，即腹腔镜手术可以结合两种手术策略的有益效果而无各自的副作用。我们得出结论，腹腔镜入路联合术中单独输注钙通道阻滞剂尼卡地平，可在血流动力学稳定的情况下通过手术切除嗜铬细胞瘤。与开放手术相比，这能更好地暴露解剖结构，并能在术前影像学检查结果不明确的情况下对整个腹腔进行可视化探查，以排除肿瘤多中心性或异位病灶。此外，如有需要，随时可转为开放手术。
