摘要
目的评价腹腔镜治疗肾上腺嗜铬细胞瘤的安全性.方法采用腹腔镜技术治疗肾上腺嗜铬细胞瘤20例(A组),同期20例开放手术者作为对照组(B组).选取术中血压、心率、血浆去甲肾上腺素(NE)浓度以及手术时间、术中出血量、术中输血例数、术后下床活动时间、术后住院时间等指标进行比较.NE的测定用反向高效液相色谱串联电化学检测内标法(RP-HPLC-ECD).结果两组患者手术均获成功.术中出现血压、心率剧烈波动者A组3例(15.0%),血压最高达220/110 mm Hg(1 mm Hg=0.133 kPa)、最低至88/57 mm Hg,心率最高122次/min;B组12例(60.0%),血压最高达210/115 mm Hg,最低至85/60 mm Hg,心率最高120次/min.每次血压及心率波动都伴有NE的明显升高,达6.28～16.82 ng/ml(正常值:0.32 ng/ml)(P＜0.01).A、B两组的手术时间分别为(70±15)min和(130±35)min,t=5.331,P＜0.001;出血量(35±15)ml和(210±80)ml,t=8.852,P＜0.001;A组术中无输血,B组15例输血;术后下床活动时间分别为(2.4±0.5)d和(5.0±0.5)d,t=10.728,P＜0.001;术后住院时间分别为(6.0±1.5)d和(9.0±2.5)d,t=6.021,P＜0.001,差异均有统计学意义.随诊2～36个月未见复发.结论有腹腔镜肾上腺瘤手术操作经验者,选择直径＜3.5 cm的肾上腺嗜铬细胞瘤开展腹腔镜手术具有相当高的安全性.
Objective To evaluate the safety and feasibility of retroperitoneal laparoscopic excision of pheochromocytoma. Methods Retroperitoneal laparoscopic excision of pheochromocytoma was performed on 20 patients with pheochromocytoma (group A).At the same period, 20 patients with pheochromocytoma undergoing open surgery served as controls (group B).Intraoperative blood pressure, heart rate, plasma noradrenalin (NE) concentration,operative time, volume of blood loss, cases receiving blood transfusion, postoperative activity out of bed days, postoperative hospital stay,were compared between the 2 groups.The NE concentration was determined using RP-HPLC-ECD. Results The operations were successful in all the patients. Intraoperatively,3 cases (15.0%) in group A and 12 cases (60.0%) in group B experienced acute fluctuation in blood pressure,heart rate and pulse [maximum blood pressure,220/110 mm Hg(1 mm Hg=0.133 kPa) vs 210/115 mmHg; minimum blood pressure,88/57 mm Hg vs 85/60!mm Hg;maximum heart rate,122/min vs 120/min, respectively].The NE concentratioo correspondingly fluctuated from the maximum 16.82 ng/ml to the minimum 6.28 ng/ml (normal reference,0.32 ng/ml) (P<0.01).The other outcomes in groups A and B were as follows: operative time,(70±15)min vs (130±35)min(t=5.331,P<0.001);volume of blood loss,(35±15)ml vs (210±80)ml ( t= 8.852,P<0.001);cases receiving blood transfusion,0 vs 15 cases; postoperative activity out of bed days,( 2.4±0.5)d vs ( 5.0± 0.5)d (t=10.728,P<0.001);postoperative hospital stay,(6.0±1.5)d vs ( 9.0±2.5)d (t= 6.021, P<0.001).The differences were statistically significant.No case had recurrence during follow-up. Conclusions Based upon the experience and skills of the surgeons,retroperitoneal laparoscopic surgery for pheochromocytoma which is less than 3.5 cm in diameter is highly feasible and safe.Retroperitoneal laparoscopic surgery has the advantages of shorter operative time,less hemorrhage and trauma, and more rapid recovery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第3期154-156,共3页
Chinese Journal of Urology
