Suprapubic robot-assisted transumbilical two-port laparoscopic adrenalectomy for huge pheochromocytoma and paraganglioma and report of 5 cases
-
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/m2。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。Abstract: 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/m2. 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 days postoperatively. The median postoperative hospital stay was 4(3-6) days. The pathological results included 3 cases of pheochromocytoma and 2 cases of paraganglioma. All patients were followed up postoperatively without tumor recurrence in a median follow-up period of 5(2-9) months. The incision healed well. Umbilical scar was obscured due to umbilical folds, and suprapubic incision was not obvious due to pubic hair. The level of 24 h urinary catecholamine returned to normal. Among the 3 patients with hypertension, 2 patients recovered after surgery, and 1 patient still needed to be treated with antihypertensive drugs, but the dosage was reduced and blood pressure was well controlled. Suprapubic robot-assisted transumbilical two-port laparoscopic adrenalectomy for huge pheochromocytoma and paraganglioma is safe and feasible with good cosmetic result, so it's worthy of clinical application.
-
Key words:
- robotic surgery /
- pheochromocytoma /
- paraganglioma /
- pubic symphysis
-
-
[1] Gagner M,Lacroix A,Bolté E.Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma[J].N Engl J Med,1992,327(14):1033.
[2] Makay O,Erol V,Ozdemir M.Robotic adrenalectomy[J].Gland Surg,2019,8(Suppl 1):S10-S16.
[3] 徐辉,张国玺,邹晓峰,等.耻骨上辅助单孔腹腔镜上尿路全切术四例报告[J].中华医学杂志,2019,99(36):2840-2843.
[4] 徐辉,张国玺,邹晓峰,等.耻骨上辅助经脐单孔腹腔镜下肾切除术:单中心学习曲线研究[J].中华泌尿外科杂志,2016,37(8):572-577.
[5] 邹晓峰,张国玺,袁源湖,等.耻骨上辅助经脐单孔腹腔镜技术在泌尿外科的应用价值(附57例报告)[J].临床泌尿外科杂志,2011,26(7):481-484,487.
[6] Zou X,Zhang G,Xue Y,et al.Suprapubic-assisted laparoendoscopic single-site surgery(LESS)in urology:our experience[J].BJU Int,2013,112(2):E92-E98.
[7] 徐刚,黎衍敏,邹晓峰,等.泌尿外科耻骨上辅助经脐单孔腹腔镜手术并发症的临床分析[J].临床泌尿外科杂志,2017,32(3):174-177.
[8] 吴玉婷,徐辉,张国玺,等.耻骨上辅助经脐单孔腹腔镜小儿重复肾切除术(附9例报告)[J].微创泌尿外科杂志,2015,4(1):6-10.
[9] 邹晓峰,徐辉,张国玺,等.经脐入路新型腹腔镜下肾上腺快速切除技术探讨[J].中华泌尿外科杂志,2014,35(10):795-796.
[10] Hamada A,Razdan S,Etafy MH,et al.Early return of continence in patients undergoing robot-assisted laparoscopic prostatectomy using modified maximal urethral length preservation technique[J].J Endourol,2014,28(8):930-938.
[11] Chung HS,Kim MS,Yu HS,et al.Laparoscopic adrenalectomy using the lateral retroperitoneal approach:Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm?[J].Int J Urol,2018,25(5):414-419.
[12] Conzo G,Musella M,Corcione F,et al.Laparoscopic adrenalectomy,a safe procedure for pheochromocytoma.A retrospective review of clinical series[J].Int J Surg,2013,11(2):152-156.
[13] 张小华,王先进,高逢彬,等.经腹腔途径机器人辅助腹腔镜下肾上腺手术的经验总结(附243例报告)[J].中华泌尿外科杂志,2017,38(4):277-280.
[14] Agcaoglu O,Aliyev S,Karabulut K,et al.Robotic versus laparoscopic resection of large adrenal tumors[J].Ann Surg Oncol,2012,19(7):2288-2294.
[15] Cianci S,Rosati A,Rumolo V,et al.Robotic Single-Port Platform in General,Urologic,and Gynecologic Surgeries:A Systematic Review of the Literature and Meta-analysis[J].World J Surg,2019,43(10):2401-2419.
[16] 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.
-
计量
- 文章访问数: 550
- PDF下载数: 145
- 施引文献: 0
下载: