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目的探讨经腹膜后入路施行腹腔镜肾上腺嗜铬细胞瘤切除术的疗效。方法行腹膜后腹腔镜肾上腺嗜铬细胞瘤切除术32例,术前经尿VMA、MRI及~(131)I-MIBG确诊为肾上腺嗜铬细胞瘤26例,拟诊嗜铬细胞瘤6例。术前均用苯苄胺等药物准备2～4周。手术采用气管内麻醉,取患侧向上的全侧卧位,经腹膜后入路,“手指分离法”建立腹膜后工作空间,显露肿瘤,用超声刀分离肿瘤周围组织,较大的血管及肾上腺中央静脉用钛夹双重钳夹后剪断,将瘤体置入标本袋内取出。结果32例均在腹膜后腹腔镜下顺利切除肿瘤。手术时间45～180 min,平均(91.2±22.5)min。出血量20～160 ml,平均(64.3±24.1)ml。29例(90.6%)在分离瘤体时血压波动<40 mm Hg。瘤体直径28～53 mm,平均(39.5±7.7)mm。术后血压稳定,疼痛较轻,术后4～9 d出院。病理检查证实均为肾上腺嗜铬细胞瘤。结论腹膜后腹腔镜肾上腺嗜铬细胞瘤切除术具有操作精细准确,不需过多地推动和挤压肿瘤,出血少,创伤小,恢复快等优点。
Objective To investigate the effect of laparoscopic adrenal pheochromocytoma via retroperitoneal approach. Methods Thirty-two cases of retroperitoneal laparoscopic adrenal pheochromocytoma were performed. Preoperative diagnosis of adrenal pheochromocytoma by VMA, MRI and ~ (131) I-MIBG were performed in 26 cases and pheochromocytoma was diagnosed in 6 cases. Preoperative benzene benzylamine and other drugs are prepared 2 to 4 weeks. Surgical use of endotracheal intubation, take lateral full lateral position, the retroperitoneal approach, “finger separation method ” to establish a retroperitoneal space, revealing the tumor, the use of ultrasonic scalpel separation of tumor surrounding tissue, larger blood vessels And the central adrenal double clip with a titanium clip after clipping, the tumor into the specimen bag removed. Results All 32 cases underwent retroperitoneal laparoscopic resection of the tumor successfully. The operative time was 45-180 min (mean, 91.2 ± 22.5) min. Bleeding volume 20 ~ 160 ml, average (64.3 ± 24.1) ml. Twenty-nine patients (90.6%) had a blood pressure fluctuation of <40 mm Hg when the tumor was isolated. The diameter of the tumor was 28-53 mm, with an average of (39.5 ± 7.7) mm. Postoperative blood pressure stability, less pain, 4 to 9 days after discharge. Pathological examination confirmed adrenal pheochromocytoma. Conclusion retroperitoneal laparoscopic adrenal pheochromocytoma resection with precise and precise operation without excessive push and squeeze the tumor, less bleeding, less trauma, faster recovery and so on.