【摘要】 目的比较后腹腔镜与开放手术治疗肾上腺嗜铬细胞瘤的临床效果,评价后腹腔镜肾上腺嗜铬细胞瘤切除术的临床应用价值。方法回顾分析1998年1月~2005年12月我院50例单侧开放性肾上腺嗜铬细胞瘤手术(开放手术组)和53例单侧后腹腔镜肾上腺嗜铬细胞瘤手术(后腹腔镜组)的临床资料,比较2组手术情况(手术创伤相关指标、术中高血压波动、疗效等)。结果后腹腔镜组手术时间(52±22)min显著短于开放手术组(120±42)min,(t=-11.692,P=0.000);术中出血量(74±34)ml显著少于开放手术组(187±64)ml(t=-7.511,P=0.000);术后肠道功能恢复时间(中位数1d vs2d,u=-5.018,P=0.000)和术后住院时间[(5.2±1.7)d vs(8.3±1.8)d,t=-10.714,P=0.000]均明显优于开放手术组。后腹腔镜组术中高血压发生例数(9例vs18例,χ2=4.811,P=0.028)、输血例数(1例vs8例,χ2=6.426,P=0.011)、全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)发生例数(11例vs21例,χ2=5.423,P=0.020)均显著低于开放组;2组SIRS持续时间(中位数1d vs1d,u=-1.598,P=0.110)、手术并发症发生例数(2例vs6例,χ2=1.418,P=0.234)无统计学差异。术后3个月血压恢复正常及症状消失者后腹腔镜组有45例(84.9%),开放手术组43例(86.0%),2组比较无统计学差异(χ2=0.025,P=0.875)。103例随访5~36个月,平均21.3月,均未出现肿瘤复发和转移。结论后腹腔镜肾上腺嗜铬细胞瘤手术不仅手术时间短、出血量少、对患者的创伤小,而且术中对血压的控制较好,具有与开放手术相似的疗效,是治疗肾上腺嗜铬细胞瘤安全、有效的方法。更多还原

【Abstract】 Objective To compare the clinical efficacy and evaluate the clinical value of retroperitoneoscopic adrenalectomy and open adrenalectomy in treating adrenal pheochromocytoma.Methods Retrospective analysis was conducted with clinical data of 50 cases of unilateral open adrenalectomy(open group)and 53 cases of unilateral retroperitoneoscopic adrenalectomy(retroperitoneoscopic group)from January 1998 to December 2005.The differences between the two groups were studied focusing on the surgical trauma related indexes,blood pressure fluctuation during the operation and clinical efficacy.Results The mean operation time(52±22)min vs(120±42)min(t=-11.692,P=0.000),blood loss(74±34)ml vs(187±64)ml(t=-7.511,P=0.000),recovery time of gastrointestinal function(median 1 d vs 2 d,u=-5.018,P=0.000)and mean hospital stay(5.2±1.7)d vs(8.3±1.8)d,(t=-10.714,P=0.000)of retroperitoneoscopic group were significantly lower than those of the open group.The incidence of hypertension during the operation(9 cases vs 18 cases,χ2=4.811,P= 0.028),the cases requiring blood transfusion(1 case vs 8 cases,χ2=6.426,P=0.011)and incidence of systemic inflammatory response syndrome(SIRS)(11 cases vs 21 cases,χ2= 5.423,P=0.020)of retroperitoneoscopic group were lower than those of the open group,while there was no difference in duration of SIRS(median 1 d vs 1 d,u=-1.598,P=0.110)or operative complications(2 cases vs 6 cases,χ2=1.418,P=0.234)between the two groups.The proportions of patients whose blood pressure returned to normal and symptoms disappeared 3 months after operation were 84.9%(45/53)and 86.0%(43/50)in retroperitoneoscopic and open groups,respectively(χ2=0.025,P=0.875).During the follow-up of 5-36 months(mean:21.3 months)in 103 cases,there were no tumor recurrences or metastasis.Conclusions Retroperitoneoscopic adrenalectomy for pheochromocytoma has advantages such as shorter operation time,less blood loss,minimal invasion,better intraoperative control of blood pressure,and similar clinical efficacy with open surgery.It is therefore a safe and effective method in treating pheochromocytoma.更多还原