单孔腹腔镜手术处理腹主动脉旁异位嗜铬细胞瘤4例报告  

Laparoendoscopic single-site transperitoneal laparoscopic resection for extra-adrenal pheochromocytoma(Report of 4cases)

作　　者：郭刚[1] 蔡伟[1] 张旭[1] 俞鸿凯[1] 李宏召[1] 祝强[1] 

机构地区：[1]解放军总医院泌尿外科,北京100853

出　　处：《临床泌尿外科杂志》2014年第7期589-592,共4页Journal of Clinical Urology

摘　　要：目的：探讨经腹腹腔镜自制手套单孔腹腔镜（LESS）手术治疗异位嗜铬细胞瘤的可行性和安全性。方法：对4例异位肾上腺嗜铬细胞瘤患者采用经腹腹腔镜自制手套LESS术切除肿瘤。男3例,女1例,年龄35～58岁,肿瘤最大径5.0～6.5cm。肿瘤位于右侧肾下部主动脉和下腔静脉之间2例,左肾下部与主动脉之间2例。术前常规降压扩容治疗2～3周,术中取45°健侧卧位,取患侧脐旁腹直肌外缘切口长5cm,应用自制2环-手套方法。形成单切口多通道操作方式。应用常规腹腔镜器械操作,显露并切除瘤体。结果：所有患者均顺利完成手术,其中3例在腹腔镜下完成手术,1例因多次动脉夹夹闭基底血管失败,转开放手术。手术时间120～160min,平均145min。术中出血100～200ml,平均165ml,均未给予输血治疗。术中出现血压波动者3例,收缩压峰值160～220mmHg,舒张压峰值100～160mmHg。术后住院时间4～7d,平均5.5d。4例患者均未出现术后并发症。所有患者病理结果均为嗜铬细胞瘤。结论：应用经腹腹腔镜自制手套LESS术可以较好的处理腹部的异位嗜铬细胞瘤,没有增加手术风险和操作难度。既可以充分发挥腹腔镜精细操作的技术优势,又为迅速中转开放手术提供了便利条件。LESS单切口用于取出标本,转开放手术切口在10cm以内,较常规开放手术切口明显减小。Objective：Resection of extra-adrenal pheochromocytoma necessitates meticulous surgical procedures because of changes in anatomic disposition and/or proximity to major blood vessels.We present the initial experience with single-port laparoscopic transperitoneal laparoscopic resection for extra-adrenal pheochromocytoma by using a homemade single port device.Method：Four patients with extra-adrenal pheochromocytoma in our center underwent transperitoneal laparoendoscopic single-site resection by using a homemade single-port device.The study included three male and one female patients,the range of age from 35to 58years.The mean tumor size was5.5cm（range 5.0-6.5cm）.The tumors of two cases located at the left side of aorta and two at right side.Blood pressure control and fluid expansion therapy was given to every patient two weeks before operation.An incision the size of 5cm was made at the exterior margin of rectus beside the umbilicus.Two control loops were inserted into a powder-free latex surgical glove（size 8）,then the glove was enfolded 2times along the loops,thus making a single-port device with multiple manipulation channels,through which the routine laparoscopic instruments could pass.Transperitoneal laparoscopic resection of extra-adrenal pheochromocytoma was performed.Result：Transperitoneal laparoendoscopic single-site resection of extra-adrenal pheochromocytoma were performed successfully on all the four patients.One patient conversed to open surgery.The mean operative time was 145minutes（range120-160minutes）.The estimated blood loss ranges from 100-200ml,mean 165ml.No patients needed blood transfusion.Blood pressure fluctuations appeared in three patients during the operation.The peak of contractive pressure was 160to 220mmHg and diastolic pressure was 100to 160mmHg.The mean length of stay postoperation was 5.5days（range four to seven days）.No postoperative complications occurred in every patient.Pathological diagnosis showed pheochromocytoma in all patients.Conclusion：It appears to

关 键 词：单孔腹腔镜 肾上腺切除术 嗜铬细胞瘤 

分 类 号：R736[医药卫生—肿瘤]