Janetschek G, Finkenstedt G, Gasser R, Waibel U G, Peschel R, Bartsch G, Neumann H P
Department of Urology, University of Innsbruck, Austria.
J Urol. 1998 Aug;160(2):330-4. doi: 10.1016/s0022-5347(01)62886-6.
Surgical treatment of pheochromocytoma includes adrenalectomy, adrenal sparing surgery and excision of extraadrenal paragangliomas. We report our experience using laparoscopy for these procedures.
Between June 1992 and November 1997, 19 patients underwent laparoscopic surgery for pheochromocytoma. Of the patients 14 had solitary tumors, and 4 presented with bilateral pheochromocytomas and 1 or 2 additional paragangliomas. In 1 patient a recurrent pheochromocytoma was found in the contralateral adrenal following previous right adrenalectomy. One patient each had myocardiopathy, amaurosis and stroke secondary to severe hypertension. Two patients were pregnant.
All solitary tumors were treated with laparoscopic adrenalectomy. Laparoscopic adrenal sparing surgery (4 cases, 2 bilateral) and bilateral adrenalectomy (1) were performed for multiple familial pheochromocytoma, and all paragangliomas were excised simultaneously. The pregnant patients underwent surgery at 16 and 20 weeks of gestation, respectively. All procedures were completed as planned. The rate of minor intraoperative and postoperative complications was 11% and 16%, respectively, and there were no major complications. In all patients the catecholamine levels returned to normal and no residual tumors were found at followup. None of the patients undergoing partial resection required steroid replacement therapy.
In experienced hands, laparoscopic surgery for solitary and multiple pheochromocytoma and paraganglioma is feasible and safe, and does not increase the specific risks associated with pheochromocytoma surgery.
嗜铬细胞瘤的外科治疗包括肾上腺切除术、保留肾上腺手术以及肾上腺外副神经节瘤切除术。我们报告了我们使用腹腔镜进行这些手术的经验。
1992年6月至1997年11月期间，19例患者接受了嗜铬细胞瘤的腹腔镜手术。其中14例患者为单发肿瘤，4例为双侧嗜铬细胞瘤并伴有1个或2个额外的副神经节瘤。1例患者在先前右侧肾上腺切除术后，对侧肾上腺发现复发性嗜铬细胞瘤。1例患者继发于严重高血压，患有心肌病、黑矇和中风。2例患者为孕妇。
所有单发肿瘤均采用腹腔镜肾上腺切除术治疗。对于多发性家族性嗜铬细胞瘤，进行了腹腔镜保留肾上腺手术（4例，2例双侧）和双侧肾上腺切除术（1例），并同时切除所有副神经节瘤。2例孕妇分别在妊娠16周和20周时接受了手术。所有手术均按计划完成。术中及术后轻微并发症发生率分别为11%和16%，无严重并发症。所有患者的儿茶酚胺水平均恢复正常，随访时未发现残留肿瘤。接受部分切除术的患者均无需类固醇替代治疗。
在经验丰富的医生手中，腹腔镜手术治疗单发和多发嗜铬细胞瘤及副神经节瘤是可行且安全的，不会增加与嗜铬细胞瘤手术相关的特定风险。
