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目的探讨机器人腹腔镜手术治疗压迫大血管复杂嗜铬细胞瘤的可行性及安全性。方法 2013年2月至2013年3月采用达芬奇机器人辅助腹腔镜设备治疗3例压迫大血管复杂嗜铬细胞瘤患者。男1例,女2例。2例表现为阵发性头晕、心悸和血压升高,1例表现为心悸伴胸痛。CT、超声和实验室检查诊断为嗜铬细胞瘤。1例为左侧肾上腺外嗜铬细胞瘤(副神经节瘤),肿瘤位于左肾中下极水平腹主动脉旁,大小为4.8cm×3.8cm。2例为右侧肾上腺嗜铬细胞瘤,肿瘤紧贴肝叶、压迫下腔静脉,大小分别为6.5cm×4.6cm和4.9cm×4.7cm。3例均采用经腹腔途径,对于左侧副神经节瘤,置入4个Trocar(3个机械臂和1个辅助孔)完成手术,对于右侧肾上腺嗜铬细胞瘤,置入5个Trocar(3个机械臂和2个辅助孔)完成手术。结果 3例手术均成功完成,1例术中血压波动为50mmHg,2例术中血压波动≤30mmHg。达芬奇系统定位平均时间为10min,手术时间分别为120、60、85min,术中出血量分别为200、100、200ml,术后住院时间分别为5、7、4d。3例患者术后症状消失,血压恢复正常,均无继发性出血、感染等并发症。术后病理均诊断为嗜铬细胞瘤。术后随访2~3个月,未见肿瘤复发。结论压迫腔静脉、腹主动脉等大血管的嗜铬细胞瘤情况复杂,采用传统腹腔镜手术较为困难。采用达芬奇机器人辅助腹腔镜手术进行治疗具有操作精细、安全性高、并发症少等优点,值得临床应用。
Objective To investigate the feasibility and safety of robotic laparoscopic surgery in the treatment of complex pheochromocytoma of large vessels. Methods From February 2013 to March 2013, 3 patients with large complex pheochromocytoma were treated with da Vinci robot assisted laparoscopic device. 1 males and 2 females. 2 cases showed paroxysmal dizziness, palpitations and blood pressure, 1 case of palpitations with chest pain. CT, ultrasound and laboratory tests diagnosed as pheochromocytoma. One case was left adrenal extra-pheochromocytoma (paraganglioma). The tumor was located next to the middle- and lower-pole abdominal aorta of the left kidney with a size of 4.8 cm × 3.8 cm. 2 cases of right adrenal pheochromocytoma, close to the liver tumor, oppression of the inferior vena cava, the size of 6.5cm × 4.6cm and 4.9cm × 4.7cm. All 3 patients underwent transperitoneal approach. For the left paraganglioma, four Trocar (three robotic arms and one auxiliary hole) were placed for surgery. For the right adrenal pheochromocytoma, five Trocar ( 3 robotic arms and 2 auxiliary holes) to complete the operation. Results All the three cases were successfully performed. One case had a 50 mmHg intraoperative blood pressure fluctuation and two cases had intraoperative blood pressure fluctuation ≤30 mmHg. The mean time of localization of Da Vinci system was 10 min, the operation time was 120, 60, 85 min, the blood loss was 200, 100 and 200 ml respectively, and the postoperative hospital stay was 5, 7 and 4 days respectively. 3 patients disappeared after surgery, blood pressure returned to normal, no secondary bleeding, infection and other complications. Postoperative pathology were diagnosed as pheochromocytoma. Follow-up 2 to 3 months after surgery, no tumor recurrence. Conclusions Complications of pheochromocytoma, such as vena cava and abdominal aorta, are complex, and traditional laparoscopic surgery is more difficult. The use of Da Vinci robot-assisted laparoscopic surgery has the advantages of fine operation, high safety, fewer complications and is worth clinical application.