耻骨上机器人辅助经脐双通道腹腔镜巨大嗜铬细胞瘤/副神经节瘤切除术5例报告  

Suprapubic robot-assisted transumbilical two-port laparoscopic adrenalectomy for huge pheochromocytoma and paraganglioma and report of 5 cases

作　　者：徐刚[1] 张国玺[1] 邹晓峰[1] 袁源湖[1] 肖日海[1] 伍耿青[1] 钱彪 王晓宁[1] 徐辉[1] 刘佛林[1] 吴玉婷[1] 廖云峰[1] 刘全亮[1] 谢天朋[1] 何志华 江波[1] 邹毓华[1] 张兆林[1] 曾庆明[1] 刘林伟[1] XU Gang;ZHANG Guoxi;ZOU Xiaofeng;YUAN Yuanhu;XIAO Rihai;WU Gengqing;QIAN Biao;WANG Xiaoning;XU Hui;LIU Folin;WU Yuting;LIAO Yunfeng;LIU Quanliang;XIE Tianpeng;HE Zhihua;JIANG Bo;ZOU Yuhua;ZHANG Zhaolin;ZENG Qingming;LIU Linwei(Department of Urology,First Affiliated Hospital of Gannan Medical University,Jiangxi Province Engineering Technology Research Center for Prevention and Treatment of Calculus,Ganzhou,Jiangxi,341000,China)

机构地区：[1]赣南医学院第一附属医院泌尿外科,江西省结石防治工程技术研究中心,江西赣州341000

出　　处：《临床泌尿外科杂志》2021年第3期228-231,共4页Journal of Clinical Urology

基　　金：江西省科技厅重点研发计划一般项目(No:20202BBG73021);江西省科技厅科技计划项目(No:20151BBG70070);江西省教育厅科学技术研究项目(No:GJJ190820)。

摘　　要：总结耻骨上机器人辅助经脐双通道腹腔镜巨大嗜铬细胞瘤/副神经节瘤(pheochromocytoma and paraganglioma,PPGL)切除术的经验与体会,探讨其安全性和可行性。回顾性分析2019年8月—2020年3月我院施行的5例耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除术的临床资料。男4例,女1例,中位年龄45.5(26~57)岁,中位BMI 23.4(20.4~24.8) kg/m^(2)。中位收缩压142(115~220) mmHg,中位舒张压106(78~140) mmHg,中位心率98(72~114)次/min。伴有高血压病史3例,其中1例曾有脑梗死病史;其余2例无特异性症状,为体检时发现。肿瘤位于右肾上腺区3例,左肾上腺区1例,左肾门部1例;中位肿瘤最大径6.5(6.0~8.3) cm。术前中位24 h尿多巴胺896.4(650.7~1 236.3)μg/24 h,中位24 h尿去甲肾上腺素450.7(114.6~775.8)μg/24 h,中位24 h尿肾上腺素66.5(45.6~114.8)μg/24 h,均升高。记录手术时间、出血量及住院时间等指标。本组5例手术均顺利完成,无中转开放或普通腹腔镜手术。中位手术时间115(75~165) min,中位术中估计失血量90(50~180) mL。术中、术后均未发生严重并发症,均未输血。所有患者术后恢复顺利。术后24 h中位视觉模拟疼痛评分(VAS)2(1~3)分,术后第1~2天下床活动,术后第2~3 d拔除腹腔引流管。中位术后住院时间4(3~6) d。术后病理诊断:嗜铬细胞瘤3例,副神经节瘤2例。所有患者均获随访,中位随访时间5(2~9)个月。切口愈合良好,脐部瘢痕因被脐部皱褶遮蔽而不明显,耻骨上切口被阴毛遮蔽而不易察觉;无肿瘤复发;24 h尿儿茶酚胺均恢复正常;术前3例血压升高者,术后血压均恢复正常2例,1例仍需口服降压药治疗,但药量减少且血压控制良好。耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除手术安全、可行,且美容优势显著,值得临床应用。We summarized the experience of suprapubic robot-assisted transumbilical two-port laparoscopic adrenalectomy for huge pheochromocytoma and paraganglioma and evaluated its safety and feasibility. A retrospective analysis was performed on the clinical data of 5 patients who underwent suprapubic robot-assisted transumbilical two-port laparoscopic adrenalectomy for huge pheochromocytoma and paraganglioma in our hospital from August 2019 to March 2020. The five patients included 4 males and 1 female. The median age was 45.5(26-57) years, and the median body mass index(BMI) was 23.4(20.4-24.8) kg/m^(2). The median systolic blood pressure was 142(115-220) mmHg, the median diastolic blood pressure was 106(78-140) mmHg, and the median heart rate was 98(72-114) bpm. There were 3 patients with hypertension, including 1 patient with cerebral infarction. The other 2 patients had no specific symptoms and the tumors were found during physical examination. There were 3 cases whose tumor located in right adrenal region, one located in left adrenal region and one located in left renal hilum. The median diameter of the tumor was 6.5(6.0-8.3) cm. The median 24 h urinary dopamine was 896.4(650.7-1 236.3) μg/24 h, the median 24 h urinary noradrenaline was 450.7(114.6-775.8) μg/24 h, and the median 24 h urinary adrenaline was 66.5(45.6-114.8) μg/24 h, which all increased. The indexes including operation time, blood loss and hospitalization time were recorded. All the 5 procedures were completed successfully, and none of which was converted to open surgery or ordinary laparoscopic surgery. The median operative time was 115(75-165) min. The median estimated blood loss was 90(50-180) mL. None of the 5 patients received blood transfusion, and no serious complication occur during and after operations. All patients recovered well after surgery. Twenty-four hours after the surgery, the median visual analogue scale(VAS) score of pain was 2(1-3). All patients resumed ambulation on 1-2 days postoperatively. The drainages were removed on 2-3 d

关 键 词：机器人手术 嗜铬细胞瘤 副神经节瘤 耻骨联合 

分 类 号：R736.6[医药卫生—肿瘤]