CAJ | 학술논문

目的探讨经脐单孔腹腔镜下腹膜后副神经节瘤切除手术的安全性及可行性.方法 2010年10月至2011年10月对5例腹膜后副神经节瘤患者施行经脐单孔腹腔镜手术.男4例,女1例.年龄24～52岁,平均38岁.临床表现为发作性高血压3例,持续性高血压1例,功能静止型1例.肿瘤位于左肾门部2例,左肾下极水平腹主动脉旁、右肾门部、右肾下极水平腹主动脉与下腔静脉之间各1例；肿瘤最大直径2,5～6.0 cm.术前分别给予α-受体阻滞剂(酚苄明)药物准备2～4周,行经脐单孔腹腔镜下副神经节瘤切除.4例采用经结肠旁沟途径,根据肿瘤位置分别剪开左或右侧结肠旁沟的侧腹膜,分离结肠脾曲或肝曲,将结肠向内侧翻起显露并切除肿瘤；对1例明显突向腹侧的肿瘤采用经肠系膜途径,于升结肠内侧剪开肿瘤表面的肠系膜,直接显露并切除肿瘤.结果 5例手术均获成功,无中转标准腹腔镜或开放手术病例.术中收缩压90～190 mm Hg(1 mm Hg=0.133 kPa),舒张压55～130mm Hg.手术时间80～190 min,平均150 min；术中出血量50～ 150 ml,平均85 ml.无手术相关并发症.4例血压升高者术后血压均恢复正常.术后住院时间3～6d,平均4.7d.术后病理均证实为副神经节瘤.脐部伤口均愈合良好,瘢痕为脐部皮肤皱褶遮盖,美容效果较好.随访3～15个月,未见肿瘤复发. 结论经脐单孔腹腔镜下腹膜后副神经节瘤切除手术安全、可行,美容效果好.
목적 탐토경제단공복강경하복막후부신경절류절제수술적안전성급가행성.방법 2010년10월지2011년10월대5례복막후부신경절류환자시행경제단공복강경수술.남4례,녀1례.년령24～52세,평균38세.림상표현위발작성고혈압3례,지속성고혈압1례,공능정지형1례.종류위우좌신문부2례,좌신하겁수평복주동맥방、우신문부、우신하겁수평복주동맥여하강정맥지간각1례；종류최대직경2,5～6.0 cm.술전분별급여α-수체조체제(분변명)약물준비2～4주,행경제단공복강경하부신경절류절제.4례채용경결장방구도경,근거종류위치분별전개좌혹우측결장방구적측복막,분리결장비곡혹간곡,장결장향내측번기현로병절제종류；대1례명현돌향복측적종류채용경장계막도경,우승결장내측전개종류표면적장계막,직접현로병절제종류.결과 5례수술균획성공,무중전표준복강경혹개방수술병례.술중수축압90～190 mm Hg(1 mm Hg=0.133 kPa),서장압55～130mm Hg.수술시간80～190 min,평균150 min；술중출혈량50～ 150 ml,평균85 ml.무수술상관병발증.4례혈압승고자술후혈압균회복정상.술후주원시간3～6d,평균4.7d.술후병리균증실위부신경절류.제부상구균유합량호,반흔위제부피부추습차개,미용효과교호.수방3～15개월,미견종류복발. 결론 경제단공복강경하복막후부신경절류절제수술안전、가행,미용효과호.
Objective To discuss the safety and feasibility of transumbilical laparoendoscopic single-site resection of postperitoneal paraganglioma. Methods Five patients with postperitoneal paraganglioma accepted transumbilical laparoendoscopic single-site surgery from October 2010 to October 2011.Four patients were male and 1 patient was female aged from 24 to 52 years with the average age of 38 years.Three patients presented with paroxysmal hypertension,1 patient with persistent hypertension,and the other with no symptom.The tumors were located on left postperitoneum in 3 cases (2 adjacent to left renal vessels,the other para-aortic),and right postperitoneum in 2 cases (1 adjacent to right renal vessels,the other between inferior vena cava and aorta).The diameter of tumors ranged from 2.5 cm to 6.0 cm.or-blocker was given for preoperational preparation.After 2 -4 weeks,transumbilical laparoendoscopic single-site resection of tumors were administered.Transparacolic route was selected in 4 cases and the other was operated through mesentery. Results All the operations were successful.None was converted to conventional laparoscopic surgery or open surgery.The operative time ranged from 80 to 190 min,the mean was 150 min.The blood loss ranged from 50 to 150 ml,the average blood loss was 85 ml. No operation-related complications ocurred.Four cases with hypertension returned to normal blood pressure.All cases recovered uneventfully and discharged in 3 to 6 d after operation.Postoperational pathologic result proved the diagnosis of paraganglioma.The wound healed very well and the scars were occult.Follow-up was performed in all cases for 3 to 15 months.No recurrence was found. Conclusion Transumbilical laparoendoscopic single-site resection of postperitoneal paraganglioma could be safe and effective,and has good cosmetic effect.