CAJ | 학술논문

目的:比较开放手术、经腹腹腔镜和后腹腔镜3种手术方法治疗肾上腺嗜铬细胞瘤的临床效果.方法:回顾性分析54例诊断肾上腺嗜铬细胞瘤患者临床资料,其中男27例,女27例,年龄19～71岁,肿瘤直径1.5～7.0cm,50例有高血压症状,病程2个月～15年,所有患者影像学检查未见周围脏器浸润和远处转移.根据手术方式分为三组:A组为开放手术肾上腺嗜铬细胞瘤切除组,20例;B组为经腹腹腔镜肿瘤切除组,16例;C组为后腹腔镜肿瘤切除组,18例.比较3组手术时间、术中出血量、术中发生血压剧烈波动、术后肠道功能恢复时间、住院时间、术后血压下降情况,并进行统计学分析.结果:所有手术均获成功,术中、术后未出现明显并发症,病理检查均为嗜铬细胞瘤.A、B、C 3组手术时间分别为:(120.60±18.18)min、(105.13±17.46)min、(102.22±16.01)min;术中出血量分别为:(146.50±36.20)mL、(116.56±37.32)mL,(120.28±33.80)mL;术中发生血压剧烈波动分别为:12例、5例、5例;术后肠道功能恢复时间分别为:(2.40±0.79)d、(1.75±0.45)d、(1.58±0.49)d;住院时间分别为:(11.15±1.87)d、(5.94±0.85)d、(5.94±0.80)d.以上五项A组与B、C组间比较,差异有统计学意义(P<0.05);B、C组间比较差异无统计学意义(P>0.05).术后血压恢复正常或明显下降分别为18例、15例、17例,3组间比较差异无统计学意义(P>0.05).所有病例随访9个月～年,无肿瘤复发.结论:经腹腔和经后腹腔腹腔镜肾上腺嗜铬细胞瘤切除术具有创伤小、恢复快、安全性高等优点,疗效与开放手术相当,可作为治疗肾上腺嗜铬细胞瘤首选方法.
목적:비교개방수술、경복복강경화후복강경3충수술방법치료신상선기락세포류적림상효과.방법:회고성분석54례진단신상선기락세포류환자림상자료,기중남27례,녀27례,년령19～71세,종류직경1.5～7.0cm,50례유고혈압증상,병정2개월～15년,소유환자영상학검사미견주위장기침윤화원처전이.근거수술방식분위삼조:A조위개방수술신상선기락세포류절제조,20례;B조위경복복강경종류절제조,16례;C조위후복강경종류절제조,18례.비교3조수술시간、술중출혈량、술중발생혈압극렬파동、술후장도공능회복시간、주원시간、술후혈압하강정황,병진행통계학분석.결과:소유수술균획성공,술중、술후미출현명현병발증,병리검사균위기락세포류.A、B、C 3조수술시간분별위:(120.60±18.18)min、(105.13±17.46)min、(102.22±16.01)min;술중출혈량분별위:(146.50±36.20)mL、(116.56±37.32)mL,(120.28±33.80)mL;술중발생혈압극렬파동분별위:12례、5례、5례;술후장도공능회복시간분별위:(2.40±0.79)d、(1.75±0.45)d、(1.58±0.49)d;주원시간분별위:(11.15±1.87)d、(5.94±0.85)d、(5.94±0.80)d.이상오항A조여B、C조간비교,차이유통계학의의(P<0.05);B、C조간비교차이무통계학의의(P>0.05).술후혈압회복정상혹명현하강분별위18례、15례、17례,3조간비교차이무통계학의의(P>0.05).소유병례수방9개월～년,무종류복발.결론:경복강화경후복강복강경신상선기락세포류절제술구유창상소、회복쾌、안전성고등우점,료효여개방수술상당,가작위치료신상선기락세포류수선방법.
Objective: To compare the clinical efficacy of open surgery, peritoneal laparoscopic excision and retroperitoneal laparoscopic excision for adrenal pheochromocytoma. Methods. We retrospectively ana-lyzed the clinical data of 54 patients with adrenal pheochro-mocytoma (27 males and 27 females). Patients' age ranged from 19 to 71. The diameter of tumors ranged from 1.5 to 7.0 cm. Fifty patients had symptoms of hypertension and their course of disease ranged from 2 months to 15 years. None of the patients had inva-sion and metastasis in surrounding organs. According to modus operandi, the patients were divided into 3 groups. The 20 patients in group A underwent open surgery, the 16 patients in group B underwent peritoneal laparoscopic excision, and the 18 patients in group C underwent retroperitoneal laparoscopic excision. The surgical duration, volume of blood loss, severe blood pressure fluctuation, recovery time of intestinal function,postoperative hospital stay, and decrease of blood pressure were compared among the three groups. The re-sults were statistically analyzed. Results: All surgeries were successful, with no complications. All specimens were proved pheochromocytoma. The mean surgical duration was 120.60±18.18 min in group A, 105.13±17.46 min in group B, and 102.22±16.01 min in group C. The volume of blood loss was 146.50±36.20 mL in group A, 116.56±37.32mL in group B, and 120.28±33.80mL in group C. Twelve cases in group A, 5 cases in group B and 5 cases in group C had blood pressure fluctuation. The recovery time of intestinal function was 2.40±0.79 d in group A, 1.75±0.45 d in group B, and 1.58±0.49 d in group C. The postoperative hospital stay was 11.15±1.87 d in group A, 5.94±0.85 d in group B, and 5.94±0.80 d in group C. There was statistical signifi-cance between group A VS group B and group C (P<0.05). There was no statistical significance between group B and group C. There were 18, 15 and 17 cases in group A, B and C who had postoperative decrease of blood pressure, with no statistical difference among the three groups (P>0.05). All cases were followed up for 9 months to 6 years, with no recurrence. Conclusion: Peritoneal laparoscopic excision and retroperitoneal laparoscopic excision can be considered as the preferred choice for adrenal pheochromocytoma, with mini-mal invasion, fast recovery, and satisfactory safety.