CAJ | 학술논문

目的：总结直径≤3 cm的肾上腺小嗜铬细胞瘤的诊断经验和后腹腔镜下手术切除要点。方法回顾性分析2006年10月至2011年6月收治的32例小嗜铬细胞瘤患者的临床资料。男14例，女18例。年龄23～74岁，平均39岁。有高血压表现的功能型12例，静止型20例。肿瘤位于左侧13例，右侧18例，双侧1例。血浆游离间羟肾上腺素类物质（ MNs）和24 h尿儿茶酚胺（ CA）定性诊断的阳性率分别为92．6％（25/27）和81．3％（26/32）。超声、131I-间碘苄胍、CT或MRI检查定位诊断的准确率分别为71．9％（23/32）、93．8％（15/16）和96．9％（31/32）。32例均拟行全麻下后腹腔镜下肾上腺部分切除术。于肾脏内上方、近后腹膜处分离肾上腺，先游离寻找靠近后腹膜的肾上腺内侧支，并充分游离出整个肾上腺组织。结果32例患者中行肾上腺部分切除术30例，肾上腺全切术2例。2例中转开放手术。手术时间40～210 min，平均82 min。出血量20～180 ml，平均57 ml，无输血病例。病灶均完整切除，术后病理诊断均为良性嗜铬细胞瘤，肿瘤直径1．0～3．0 cm，平均（1．7±0．2） cm。术后随访8～49个月，平均18个月，无复发及术后并发症。结论小嗜铬细胞瘤定性诊断应联合检测血、尿CA及MNs和香草基扁桃酸（ VMA）等多种生化指标；定位诊断中超声为筛查的首选检查；CT及MRI为常规确诊检查。后腹腔镜下肾上腺部分切除术为治疗肾上腺小嗜铬细胞瘤的首选，术中先游离寻找靠近后腹膜的肾上腺内侧支、充分探查整个肾上腺组织是手术成功的关键。
목적：총결직경≤3 cm적신상선소기락세포류적진단경험화후복강경하수술절제요점。방법회고성분석2006년10월지2011년6월수치적32례소기락세포류환자적림상자료。남14례，녀18례。년령23～74세，평균39세。유고혈압표현적공능형12례，정지형20례。종류위우좌측13례，우측18례，쌍측1례。혈장유리간간신상선소류물질（ MNs）화24 h뇨인다분알（ CA）정성진단적양성솔분별위92．6％（25/27）화81．3％（26/32）。초성、131I-간전변고、CT혹MRI검사정위진단적준학솔분별위71．9％（23/32）、93．8％（15/16）화96．9％（31/32）。32례균의행전마하후복강경하신상선부분절제술。우신장내상방、근후복막처분리신상선，선유리심조고근후복막적신상선내측지，병충분유리출정개신상선조직。결과32례환자중행신상선부분절제술30례，신상선전절술2례。2례중전개방수술。수술시간40～210 min，평균82 min。출혈량20～180 ml，평균57 ml，무수혈병례。병조균완정절제，술후병리진단균위량성기락세포류，종류직경1．0～3．0 cm，평균（1．7±0．2） cm。술후수방8～49개월，평균18개월，무복발급술후병발증。결론소기락세포류정성진단응연합검측혈、뇨CA급MNs화향초기편도산（ VMA）등다충생화지표；정위진단중초성위사사적수선검사；CT급MRI위상규학진검사。후복강경하신상선부분절제술위치료신상선소기락세포류적수선，술중선유리심조고근후복막적신상선내측지、충분탐사정개신상선조직시수술성공적관건。
Objective To investigate the clinical features , diagnosis and key technique points of laparoscopic partial adrenalectomy for small adrenal pheochromocytoma . Methods From Oct.2006 to Jun. 2011, clinical data of 32 cases with small adrenal pheochromocytoma (≤3.0 cm) were collected and retro-spectively analyzed .Hypertension was observed in 12 patients, whereas 20 patients presented with adrenal incidentaloma .Thirteen patients had a left adrenal neoplasm , eighteen patients had a right adrenal tumor , while one patients had bilateral tumors .The positive rate of plasma-free metanephrines ( MNs) and 24-hours urinary catecholamine (CA) in diagnosing small renal pheochromocytomas was 92.6%(25/27) and 81.3%(26/32) respectively.The main localization diagnosis included ultrasonography , 131I-MIBG, and CT or MRI, with positive rates of 71.9%(23/32), 93.8%(15/16) and 96.9%(31/32) respectively.All the laparoscopic adrenalectomies were performed retroperitoneally .During the surgery , the internal part of the adrenal gland closing to the retroperitoneum was dissected first , and the whole adrenal gland was resected completely. Results Partial adrenalectomy was performed for 30 cases and radical adrenalectomy for 2 ca-ses.All operations were successful without perioperative or postoperative complications .The maximum diame-ter of tumor was 1.7±0.2 (1.0-3.0) cm.Histopathological results showed that all the cases were benign pheochromocytoma.The operative time was 82 (40-210) min.The estimated blood loss was 57 (20-180) ml.No patient required blood transfusion . Conclusions Plasma-free MNs, 24-hours urinary CA and VMA are important qualitative examinations in detection of adrenal pheochromocytoma .Ultrasonography , CT,MRI, and 131 I-MIBG are important in the localization of adrenal tumors .Retroperitoneal laparascopic partial adrenalectomy is the preferred choice in the management of small adrenal pheochromocytoma .Dissecting the internal part of the adrenal gland closing to the retroperitoneum first and exploring the whole adrenal tissue are the key technique points during the operations .