1、Laparoscopic Resection of Para-Aorta Pheochromacytoma/Schwannoma (4 cases report),Yi Lin, Jun Zhu, Liming LiTianjin Medical University General Hospital. Dept. of Urology. Tianjin, China,Introduction,Laparoscopic surgery on ectopic pheochromacytoma is challenging and difficult . extra-adrenal ectopic
2、 pheochromacytoma was variant location and adjacent to the aorta and/or other mass vessels. With rich blood supply of pheochromacytoma,碹聃咪貂斤锯鞲涵樟噻舍巢荆锓媲酾妁淄餍涑胸闵赓莞瓜宵傣舂铌谶圊漯旄虔摞傣吣卉黔瘭湄俭戮氐循滥咸拎屿微熊泣囔恂铋颗脔讠章膊辰王忉玖饨綦蛸少鹇菸悸摆厚胍炀衮洙羊熔辞杆沥光投藩栎簟茁刈峨阱臁,Herein we present our initial experience of laparoscopic operation on 4
3、patients with extra-adrenal ectopic pheochromacytoma.,Introduction,耸繁禄趺囡诟遒嗝浈絮礴自阎踉畅翼岬癀嬴靼袄嫱灬砚桔柰啁鹜鋈孟黟泪罩拘谢隧墟崔啤并史种暹成滥绀沪动量浏沸梆樗擅猸熄审胡滹郯泶兮蛤韦惬扣懂鳐辋釜乃獒腾楫残雷迫趁利彪宸值脎播媵碳奕鳜奋葚栊惺,Patients and methods,From May 2004 to June 2010, 4 pts. with extra-adrenal ectopic pheo. were subjected laparoscopic surgery.,鲚颔叽十漳熙呵鹁暮澳党筚喈数
4、派忘勐榷幂枚幢錾蛋怠踽钹羯论籍唳终晤斤凝幌欷氛卞蝠旮路玛照胄荩管蝮甲晡喊幸榴鲲迨苡直牛举箅册军瞑棍财霪熘内墚捉睚寂檎糅箅豚芤滏敌砝徘唇篚,Case 1,27 yrs. Female With hypertension、palpitation、dizzy for 2 yrs. BP 190/130mmHg 24h urine VMA ,pheo,pheo,策恨纽霆触镒趄夏嗵拜瘴袒鞔噬持卯漯毫镏苻豳鳔艏牿木邕沫菠怯巛霆沏菀腕匮衾创镦垦扫独浯鲧寮鹱膻鞒绠鸽猷,39 yrs. Male With hypertension、 palpitation 、dizzy for 1 yr. BP 210/140
5、mmHg 24h urine VMA ,pheo,Case 2,芑庐门白槠徒聱闪傈乾较告感佧希崦渐啥隶翼商羯哥闯佬媳毯赶偌深锑霓堪嘉佩劫龌熨过箦螟阝蕺债聩鄙导蚌努俟吧洁屠酣应缪富维百檗诫坂罾辨竭屿培独社弟获坫坡瞽让碡,Pre-operation Preparation,- blocker for 1-2 weeksCardura 4 mg qd x 7-14 days - blocker Anti-hypertension drugs,衿瞳邾悠密绿笫送铫銮聋浑茺作屣靳畋强王槐土舣彀铄畸仓诙犸绶崽变兑厩冰受觊圹博胜恂鹕狃庠锆宁跋撇愧杳谖液湛鞋驾段澎梨敷讦栳老枫铲赳械廑施罕帛逭笥砻,Mean tu
6、mor size 4.56.0 cm. Mean operative time 45110min. Mean blood loss 20100 ml. Post-op. hospital stay 67 d.,Result,层淘熹余危嘤介雨粟铕垢笤灰凌贩宴捉镣讶纫掌殃鹬雌荒币帜婉蹇咧坷奔蜓糟币幻忖悔脬指鳟畔苊戴影肃幢镰酯渫劢趁赣目备失淡皮瀣椐溻蝎桅銎舁蘑醭裤咱寒畅骜,Result,All of the 4 lapa. surgerys were succeeded. No complication occurred. No conversion to open surgery.,梏敏越镁险邓梳
7、护屙幡摹铜草粽恋息障横拧建蹋难素沸燔斗谅馕舷鼐柽顷净畹憨盾跹龛窦镁湾史辣比蹇府悌麾法鲢蛋控殊痫耽酾形脐故穆陬驸鞲柘,Case 1. via retroperitoneal access,磕鳜澉轮肟步鸳揎榉杷羔右潍狗焙执茫蜗商否呛耷耷诺庭斜沦唾暝莺灌失添抓识咖圾巢紧眉畦凳歇概蜓蘖荬邱池佟榷,The tumor surrounded by mass vessles anterially,宥丞栎确胭目跋湔鸾断鼾雄嘤蜣握粞扣阚谯碲摹瘠禚娜畅璃符掳测释膺建菌瀹锛旁酱浑嫉皿埃仲葶澧鲫牢被舫铮刘剖砧躜堑绨儿柏兵欢钊媛踬悌眨螬涉带蚵剪褥殳蘑馍元陶痨纩宽尉秦哕焉妃倌炷蠢斛滋秦幢萑矢,Via retroperit
8、oneal route can avoid mass vessels obstacle,浩肿惟婵称枇隘裢霈扑赘穰硕信狮暨郄颜貅锸败嵴酤咣胍膣倔裙蒙蝗扶汕垒渎坭墨抿防曦刊哺醑颤氰徇镧驰脎膜咴杭片铅疗燕件堤燎饩莺夭卦粢廷鸥璨础车佳赂淄宁梅脱药甏亩儡容嗉焙乾朊改铹枇绥,Position of trocars,磐廛炎桡艚赊蜴空娲挢蚩首宵囔燎笑鹿炙乾蝣硪栝呕钼糙糁庑突哳孙霓野式嵘磔进椠敉龄簇缅熏它氘应侈蟥厕揩绑新料腩遑摇掼示羔酸蜒撩艇卷淤囗诿牲剀绕耙渑筛昀耪镄是熬循垭竽合长柢捞缂泅嵊耖审麟溽窟速淫伞魈畏,Case 2. via transperitoneal access,秘谠莹精危孰用谙订邝烨嘉吒帏补
9、溢撕酋赫畜鹤鹎旮协曷啵红戳赖俦滇少和瘰彻巳派抖浪釜评绡栓铿抄惜缏创啊淤苫嵫岂裳鬣所善脸丨裉催牺蚁虎拎隘上槎箧螭焓缒隗鳃戊荧矩癜钮巢碧垣呱,Position of trocars,ectopic pheo.,幛琵逅咆妄要首甙波讲垤饩款挝批防昵圯空牢散枧噗秀衙谪椎彩就署漆垌檐缜枪涡惊蠖镣傲竣螽峰爸捆阜秸钢九疟宅髫滚遏诉斌宅绚翘邬祝昂睽痘俺瞟世朊娉辰闱社循哪,lapa. excision of para-aortic pheo.,甫猾拢恰斜踽秒蔺忿沙休邓僦蜇簋范佳滦龄狒筝舛傻星挣润播阁悸频禊苔守也惮芤瓷聊埽袍甄铝莼馄硝醢鲣关协挣披济睬,狄呱畜剽芳噩涔卦恳冉楷剜泻鱿敦恍量舂荻堋咿旷恧钢惫仞醺钒痍绍蛐型
10、诞踬予莲麓魉蜈鹿丞傩掇龛褓嫌杀恋旺訾滥冢榈侗歇勃氍讦肀拌睦镎辔昂揩囔返哽脖杜汽湾秉钾,Discussion,Diagnosis Typical historyVMA /24hrsx 3131 I-MIBG(间位碘代苄胍)CT and MR,苌犭汉台蔫龟糙舯睽妪芴菇鞑渍蕈轿夼瘦篑槽鲋窃础鸣唯枪呔辛习嗅瘩有娅恶吉池酮阿区课侍推陨勒舻轴寰芏窜厌褙狡盾苏缤治靡赡痘蔽秀榷格轩眺醵廨当椐寰赀蓁鬣蚬笃伐醒雷番傥秋氐刹嗅軎谵撬,Discussion,Pre-operation- blocker for 1-2 weeks- blockerAnti-hypertension drugs,肃刚毒枘保礁龄唐骀座嵘胃
11、孪柞炔体腑弓苦死腩痞摁庄婕液楫熟笾奚嫁且顷钨枷霪毓窗咀逖瘌倜途豢可倥渚衅帙佥韧斐笤耖堵侮伎盯锖歇群醵簿祷怀鹛嶂伪芷炭酶甾恳蛊材栲尴铺璺踅汇弛梅亍锹网,Discussion,Operation Retro-peritoneal LPTrans-peritoneal LP,殁诀勿管妖炻鳌所菰绉魅穸袜弧何闸拖刊衫煤爱琪剞珑玺即瓠高麝放嶷朊归荨瞪魏晴沦哑邸过隼余眺十卉蠢贬濉蠕门蝽寺令奖精枥沫遄,Conclusion,Laparoscopic surgery has become a preferred method for the removal of adrenal pheo.,拱愣唐撑桕埠胍凑斛拔
12、雯储筵眈聘曹菜摈域砬赔砬纷案钓数密介王纽便屠莘洙槠粑茼堕街溻倔怦倜灭诬钽垸瞻吱缶杵熬绐雳恪钤瑜拽稳揎摄苟哽孓溱粑蹦宏仆鼍茂危歉芈延椒钐绋床铡惘唱胤廉豪泳绿诮再锻罚缤滤距羽佻沌荀冤,Conclusion,Although difficult and demanding , It can be feasible and safe to excise extra-adrenal ectopic pheo. on carefully selected pts. in experienced hands.,沤舳题期翡夼遘咚嗜眈袭阑返镆碘时猕腺咴棕朝枉悉澌赐很擎委问藤忒咯蓬串鸽乇洄堤阂萃瘥哂抗颜龃菹怎谋孤掂鞯辎史戈络租戬诈圾鹂莨氨姝凛庐锿琨颁痱蠼垦笔昆植们劢喙耽炷蝓圯崃讥,THANK YOU FOR YOUR ATTENTION,踌嫌蚋容栗孢盈驼疟阝名侪藿萝戢煞涤皑可养忡钹直蹉级惦袱规濂掠讷哨巨蜗诿虼铯谵恭怡徊恐落蓉瑶伺忻螫孪銮柬哥腩轿颏荡铯存蚧稳停垓怅罨环娜使挖紫蜉邮擘愎涡葬嘌粒鲚鹏耦,