经后腹腔途径机器人辅助腹腔镜下巨大嗜铬细胞瘤切除术的临床经验总结
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摘要
目的:总结解放军总医院泌尿外科经后腹腔途径机器人辅助腹腔镜巨大嗜铬细胞瘤切除术的临床经验。方法:回顾性分析2014年1月~2016年2月间应用达芬奇机器人实施的25例经后腹腔途径机器人辅助腹腔镜巨大嗜铬细胞瘤切除术的临床资料。结果:25例手术均获得成功,无副损伤及中转开放,肿瘤位于左侧16例,右侧9例;肿瘤直径6.5~12.0cm,平均(8.43±1.31)cm;其中肾上腺嗜铬细胞瘤25例;手术时间40~100min,平均(69.9±16.7)min;术中出血量50~400ml,平均(138.0±79.4)ml,术中均未输血;其中5例未留置引流管;术后住院3~6d,平均5d。2例失访,余23获得随访6~30个月,随访期内无肿瘤复发。结论:应用机器人辅助腹腔镜技术行后腹腔途径的巨大肾上腺肿瘤切除是安全有效的手术方法,具有术中创伤小、出血少、高清成像视野清晰、机械手臂操作精细、后腹腔途径对腹部脏器的干扰小、术后恢复快等特点,是巨大肾上腺肿瘤手术的较好选择。
Objective:To summarize our experience in retroperitoneal robot-assisted laparoscopic surgery for giant pheochromocytomas.Method:We retrospectively analysed the clinical data of 25 patients with giant pheochromocytomas which were treated by retroperitoneal Da Vinci robot-assisted laparoscopic surgery from January2014 to February 2016.Result:All the operations were finished successfully with no subsidiary injury or conversion to open operation.Tumors were located at left adrenal in 16 cases and right in 9cases.The average diameter was(8.43±1.31)cm,ranging from 6.5to 12 cm.All tumors were diagnosed as adrenal pheochromocytoma.Average operative time was(69.9±16.7)min,ranging from 40 to 100min.Estimated blood loss was(138.0±79.4)ml,ranging from 50 to 400 ml,and no blood transfusion was needed.There were five cases who didn't need drainage tube.Average postoperative hospital stay was 5(range,3-6)days.All patients were followed up for 6-30 months except two cases.There was no tumor recurrence during the follow-up period.Conclusion:Retroperitoneal robot-assisted laparoscopic surgery is safe and effective in the treatment of giant adrenal tumor and has the advantages of minimal invasion,less bleeding,clear imaging,accurate operation,small interference of abdominal viscera and speedy recovery.
Objective:To summarize our experience in retroperitoneal robot-assisted laparoscopic surgery for giant pheochromocytomas.Method:We retrospectively analysed the clinical data of 25 patients with giant pheochromocytomas which were treated by retroperitoneal Da Vinci robot-assisted laparoscopic surgery from January2014 to February 2016.Result:All the operations were finished successfully with no subsidiary injury or conversion to open operation.Tumors were located at left adrenal in 16 cases and right in 9cases.The average diameter was(8.43±1.31)cm,ranging from 6.5to 12 cm.All tumors were diagnosed as adrenal pheochromocytoma.Average operative time was(69.9±16.7)min,ranging from 40 to 100min.Estimated blood loss was(138.0±79.4)ml,ranging from 50 to 400 ml,and no blood transfusion was needed.There were five cases who didn't need drainage tube.Average postoperative hospital stay was 5(range,3-6)days.All patients were followed up for 6-30 months except two cases.There was no tumor recurrence during the follow-up period.Conclusion:Retroperitoneal robot-assisted laparoscopic surgery is safe and effective in the treatment of giant adrenal tumor and has the advantages of minimal invasion,less bleeding,clear imaging,accurate operation,small interference of abdominal viscera and speedy recovery.
引文
1李军,吕文成,田野.腹腔镜手术切除巨大肾上腺肿瘤的临床探讨[J].临床泌尿外科杂志,2011,26(3):200-202.
2 Smith C D,Weber C J,Amerson J R.Laparoscopic adrenalectomy:new gold standard[J].World J Surg,1999,23(4):389-396.
3 Omura M,Saito J,Yamaguchi K,et al.Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting ageneral outpatient clinic in Japan[J].Hypertens Res,2004,27(3):193-202.
4 Zelinka T,Eisenhofer G,Pacak K.Pheochromocytoma as a catecholamine producing tumor:implications for clinical practice[J].Stress,2007,10(2):195-203.
5 Yu R,Nissen N N,Bannykh S I.Cardiac complications as initial manifestation of pheochromocytoma:frequency,outcome,and predictors[J].Endocr Pract,2012,18(4):483-492.
6 Gagner M,Lacroix A,BoltéE.Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma[J].N Engl J Med,1992,327(14):1033.
7 张旭.解剖性后腹腔镜肾上腺切除术的手术方法和技巧[J].临床泌尿外科杂志,2007,22(8):561-564.
8 Bhat H S,Nair T B,Sukumar S,et al.Laparoscopic adrenalectomy is feasible for large adrenal masses>6cm[J].Asian J Surg,2007,30(1):52-56.
9 Asher K P,Gupta G N,Boris R S,et al.Robot-assisted laparoscopic partial adrenalectomy for pheochromocytoma:the National Cancer Institute technique[J].Eur Urol,2011,60(1):118-24.
10 Brandao L F,Autorino R,Laydner H,et al.Robotic versus laparoscopic adrenalectomy:a systematic review and meta-analysis[J].Eur Urol,2014,65(6):1154-1161.
11 沈周俊,王先进,许天源.机器人辅助腹腔镜肾上腺手术的应用现状[J].临床泌尿外科杂志,2015,30(5):381-384.
12 时京,艾星,贾卓敏,等.经腹腔途径机器人辅助腹腔镜肾上腺巨大肿瘤切除术临床效果观察(附31例报告)[J].临床泌尿外科杂志,2016,31(8):682-685.
13 吕香君,张旭,马鑫,等.经后腹腔入路机器人肾部分切除术手术经验和临床疗效总结(附单中心189例病例报道)[J].微创泌尿外科杂志,2016,5(2):65-68.
2 Smith C D,Weber C J,Amerson J R.Laparoscopic adrenalectomy:new gold standard[J].World J Surg,1999,23(4):389-396.
3 Omura M,Saito J,Yamaguchi K,et al.Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting ageneral outpatient clinic in Japan[J].Hypertens Res,2004,27(3):193-202.
4 Zelinka T,Eisenhofer G,Pacak K.Pheochromocytoma as a catecholamine producing tumor:implications for clinical practice[J].Stress,2007,10(2):195-203.
5 Yu R,Nissen N N,Bannykh S I.Cardiac complications as initial manifestation of pheochromocytoma:frequency,outcome,and predictors[J].Endocr Pract,2012,18(4):483-492.
6 Gagner M,Lacroix A,BoltéE.Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma[J].N Engl J Med,1992,327(14):1033.
7 张旭.解剖性后腹腔镜肾上腺切除术的手术方法和技巧[J].临床泌尿外科杂志,2007,22(8):561-564.
8 Bhat H S,Nair T B,Sukumar S,et al.Laparoscopic adrenalectomy is feasible for large adrenal masses>6cm[J].Asian J Surg,2007,30(1):52-56.
9 Asher K P,Gupta G N,Boris R S,et al.Robot-assisted laparoscopic partial adrenalectomy for pheochromocytoma:the National Cancer Institute technique[J].Eur Urol,2011,60(1):118-24.
10 Brandao L F,Autorino R,Laydner H,et al.Robotic versus laparoscopic adrenalectomy:a systematic review and meta-analysis[J].Eur Urol,2014,65(6):1154-1161.
11 沈周俊,王先进,许天源.机器人辅助腹腔镜肾上腺手术的应用现状[J].临床泌尿外科杂志,2015,30(5):381-384.
12 时京,艾星,贾卓敏,等.经腹腔途径机器人辅助腹腔镜肾上腺巨大肿瘤切除术临床效果观察(附31例报告)[J].临床泌尿外科杂志,2016,31(8):682-685.
13 吕香君,张旭,马鑫,等.经后腹腔入路机器人肾部分切除术手术经验和临床疗效总结(附单中心189例病例报道)[J].微创泌尿外科杂志,2016,5(2):65-68.