Fernandez-Cruz L, Saenz A, Taura P, Benarroch G, Nies C, Astudillo E
Department of Surgery, University of Barcelona, Spain.
Endosc Surg Allied Technol. 1994 Dec;2(6):300-4.
A number of different surgical approaches have been devised for adrenalectomy in patients with pheochromocytoma. The anterior transabdominal approach was at one time considered a source of postoperative morbidity; the advent of laparoscopy however, may result in a resurgence in its use. The laparoscopic approach was used with a CO2 pneumoperitoneum in one patient with a left pheochromocytoma, and using a helium pneumoperitoneum in another with bilateral pheochromocytoma. The left adrenalectomy took 135 minutes to perform and the total bilateral adrenalectomy 330 minutes. No transfusion was necessary. The postoperative stay was 4 days for both patients. To prevent the risk of CO2 retention during extended laparoscopic procedures, helium can serve as an alternative gas, as was documented in the patient who underwent total adrenalectomy. Unilateral or bilateral resection of pheochromocytoma can safely be performed laparoscopically and has the advantage of avoiding both the muscular trauma related to laparotomy and the rib resection necessary for the extraperitoneal approach.
针对嗜铬细胞瘤患者的肾上腺切除术，已经设计出了多种不同的手术方法。经腹前路手术曾一度被认为是术后发病的一个原因；然而，腹腔镜技术的出现可能会导致其使用的再度兴起。一名左侧嗜铬细胞瘤患者在腹腔镜手术中使用了二氧化碳气腹，另一名双侧嗜铬细胞瘤患者则使用了氦气气腹。左侧肾上腺切除术用时135分钟，双侧肾上腺全切术用时330分钟。无需输血。两名患者的术后住院时间均为4天。为防止在长时间腹腔镜手术过程中出现二氧化碳潴留的风险，氦气可作为替代气体，接受肾上腺全切术的患者的情况就证明了这一点。嗜铬细胞瘤的单侧或双侧切除术均可通过腹腔镜安全进行，其优点是既避免了与开腹手术相关的肌肉创伤，又避免了腹膜外手术所需的肋骨切除。
