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目的:总结机器人辅助腹腔镜下嗜铬细胞瘤切除术的手术经验,探讨该术式的可行性及安全性。方法:2014年10月~2015年10月实施机器人辅助腹腔镜下嗜铬细胞瘤切除术21例,其中男11例,女10例。年龄22~72岁,平均52.2岁。肿瘤位于左肾上腺11例,右肾上腺7例,主动脉旁2例,右侧髂血管区1例。肿瘤最大径2.7~10.0cm,平均5.3cm。所有患者均完成术前定性定位检查,14例(66.7%)患者术前血儿茶酚胺升高。术前给予α阻滞剂治疗和扩容准备,记录手术方式、手术时间、出血量、住院时间等数据。结果:所有患者手术均在机器人辅助下完成,无中转开放手术者,无中转手助者。其中经腹径路手术18例,经腹膜后径路手术3例。手术时间1.50~3.38h,平均2.24h,中位手术时间2.18h。出血量10~1 000ml,平均141.4ml,中位出血量50ml。85.7%(18/21)的患者术中出现血压波动。住院时间7~22d,平均11.9d。术后1个月复查,所有术前儿茶酚胺升高的患者术后儿茶酚胺均恢复正常。结论:机器人辅助腹腔镜下嗜铬细胞瘤切除术是一种安全有效的治疗嗜铬细胞瘤的手术方式,可以按不同的肿瘤部位和大小选择经腹径路或经腹膜后径路。
OBJECTIVE: To summarize the experience of robot assisted laparoscopic surgery for pheochromocytoma and to explore the feasibility and safety of this technique. Methods: From October 2014 to October 2015, 21 cases of robot-assisted laparoscopic pheochromocytoma were performed, including 11 males and 10 females. Aged 22 to 72 years old, with an average of 52.2 years old. The tumors were located in the left adrenal gland in 11 cases, in the right adrenal gland in 7 cases, in the aorta in 2 cases and in the right iliac artery in 1 case. The largest tumor diameter 2.7 ~ 10.0cm, an average of 5.3cm. All patients completed the preoperative qualitative localization examination, 14 cases (66.7%) patients with preoperative serum catecholamines increased. Preoperative alpha blockers were prepared for treatment and expansion, and the data such as the operation method, operation time, bleeding volume and hospitalization time were recorded. Results: All patients underwent robot assisted surgery. There were no patients who transferred to open surgery and no transfer of hands. Among them, 18 cases were treated by abdominal pathology and 3 cases were treated by retroperitoneal approach. Operation time 1.50 ~ 3.38h, an average of 2.24h, the median operation time 2.18h. Bleeding volume 10 ~ 1 000ml, an average of 141.4ml, the median amount of bleeding 50ml. 85.7% (18/21) patients had intraoperative blood pressure fluctuations. Hospitalization time 7 ~ 22d, an average of 11.9d. One month after the operation, all patients with elevated catecholamines returned to normal postoperative catecholamines. Conclusions: Robot-assisted laparoscopic pheochromocytoma resection is a safe and effective surgical method for the treatment of pheochromocytoma. The transabdominal approach or the retroperitoneal approach can be chosen according to different tumor locations and sizes.