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目的探讨腹腔镜手术与开放手术治疗嗜铬细胞瘤的安全性和疗效。方法回顾性分析南京鼓楼医院2010年10月至2014年3月间住院确诊为嗜铬细胞瘤的58例患者临床资料,左侧肾上腺嗜铬细胞瘤22例,右侧26例,双侧2例,异位嗜铬细胞瘤8例。按手术方式分为腹腔镜组和开放组,比较两组术中、术后及预后相关指标。结果两组58例手术均获得成功,术后病理均确诊为嗜铬细胞瘤。腹腔镜组和开放组的手术时间分别是(162±56)min和(213±44)min(t=3.30,P=0.001);术中出血量分别是(158±402)ml和(1081±825)ml(z=-3.44,P=0.000);术后住院时间分别是(9±2)d和(12±2)d(t=4.14,P=0.000);肿瘤估算体积分别是(34±53)cm3和(197±397)cm3(z=-3.46,P=0.000);腹腔镜组(41例)的术中输血、术中高血压、术后并发症的例数分别是7例、18例、1例,开放组(17例)则分别为12例、8例、4例,除术中高血压差异不明显外,两组的术中输血、术后并发症的例数均差异显著。两组58例均获随访,随访时间为5~42个月,两组疗效满意,均未出现肿瘤复发和转移。结论腹腔镜手术治疗嗜铬细胞瘤安全、有效;同样适用于异位嗜铬细胞瘤的手术治疗。
Objective To investigate the safety and efficacy of laparoscopic surgery and open surgery for pheochromocytoma. Methods The clinical data of 58 patients with pheochromocytoma admitted to Nanjing Drum Tower Hospital from October 2010 to March 2014 were retrospectively analyzed. Twenty-two cases of left adrenal pheochromocytoma, 26 cases of right and 2 cases of bilateral , Ectopic pheochromocytoma in 8 cases. According to the method of operation, they were divided into laparoscopic group and open group. The indexes of intraoperative, postoperative and prognosis were compared between the two groups. Results The operation of 58 cases in both groups was successful. Pathology was diagnosed as pheochromocytoma. The operative time of the laparoscopic group and the open group were (162 ± 56) min and (213 ± 44) min (t = 3.30, P = 0.001) .The intraoperative blood loss were 158 ± 402 and 1081 ± 825) ml (z = -3.44, P = 0.000). The postoperative hospital stay was (9 ± 2) days and (12 ± 2) days ± 53 cm 3 and 197 ± 397 cm 3, respectively. The number of transfusions, intraoperative hypertension and postoperative complications in laparoscopic group (41 cases) were 7 cases, 18 cases, 1 case, open group (17 cases) were 12 cases, 8 cases, 4 cases, except intraoperative hypertension was insignificant, the two groups of intraoperative blood transfusion, the number of postoperative complications were significantly different . Two groups of 58 patients were followed up for 5 to 42 months, the two groups were satisfactory, no tumor recurrence and metastasis. Conclusions Laparoscopic surgery for pheochromocytoma is safe and effective. It is also suitable for the surgical treatment of ectopic pheochromocytoma.