后腹腔镜手术治疗原醛症(附90例报告)

目的探讨原醛症的后腹腔镜微创手术治疗,并与开放手术作对比分析. 方法原醛症患者90例92侧,行后腹腔镜手术,与近期开放手术治疗的30例患者的各项临床指标进行比较. 结果腔镜组92例侧手术成功91例侧,平均手术时间93 min,开放组114 min;腔镜组术中平均出血36 ml,开放组87 ml;腔镜组术后1.6 d排气,开放组3.1 d;腔镜组术后2.1 d下地活动,开放组3.3 d;腔镜组术后平均住院6.8 d,开放组11.0 d,两组各项指标差异均有显著性意义,P<0.05. 结论与开放手术相比,治疗原醛症采用后腹腔镜微创手术具有创伤小、出血少、恢复快、住院时间短等优点.     

腹腔镜肾上腺全切除术与部分切除术治疗原发性醛固酮增多症的疗效比较

目的:探讨腹腔镜肾上腺全切除术与部分切除术治疗原发性醛固酮增多症的疗效.方法:回顾分析79例原发性醛固酮增多症患者的临床资料,47例行腹腔镜肾上腺全切除术,32例行部分切除术.分析患者高血压、低血钾的恢复情况.结果:本组79例均经后腹腔途径顺利完成手术,手术时间22～115min,平均(43±5)min,术中出血15～...     

后腹腔镜肾上腺肿瘤切除术j肖思·纪要

手术适应证：（1）无功能肾上腺瘤;（2）原发性醛固酮增多症;（3）皮质醇腺瘤;（4）肾上腺囊肿;（5）肾上腺嗜铬细胞瘤直径〈5cm。     

腹膜后腹腔镜肾上腺部分切除术与全切除术治疗醛固酮瘤的对比研究

目的 比较腹膜后腹腔镜肾上腺部分切除术与全切除术治疗肾上腺醛固酮瘤的治疗效果.方法 回顾性分析我院94 例醛固酮瘤临床资料.34 例行后腹腔镜下肾上腺全切除术,60 例行后腹腔镜下肾上腺部分切除术.术后随访6~60 个月,平均24.5 个月.结果 行肾上腺全切组手术时间(40.0±12.0)min,术中失血量(23.5±9.5)ml,拔引流管时间(2.5±1.2)d,肿瘤大小(20.0±5.0)mm,术后住院天数(6.5±2.0)d.行肾上腺部分切除组手术时间(48.0±13.0)min,术中失血量(25.5±10.0)ml,拔引流管时间(2.8±1.4)d;肿瘤大小(18.5±4.5)mm;术后住院天数(7.0±2.5)d.肾上腺全切除组和部分切除组的肿瘤大小、术中失血量、住院时间和拔引流管时间差异无统计学意义(P>0.05).全切除组手术时间短于部分切除组(P<0.05).全切组术和部分切除组术后有效率分别为100%(34/34)和96.7%(58/60),两组间差异无统计学意义(P>0.05).结论 单发肾上腺醛固酮瘤适合于肾上腺部分切除术,肿瘤多灶性是保留肾上腺组织手术治疗无效的主要原因.对于部分切除术治疗无效患者,再次行患侧肾上腺全切除或肿瘤切除均可获得良好疗效.     

腹腔镜肾上腺切除术治疗原发性醛固酮增多症合并2型糖尿病患者的临床研究

目的探讨腹腔镜肾上腺切除术治疗合并2型糖尿病的原发性醛固酮增多症患者的临床效果。方法回顾性分析自2013年1月至2013年12月间本单位收治的11例合并2型糖尿病的肾上腺醛固酮瘤(APA)所致原醛症患者,接受腹腔镜患侧肾上腺切除手术前后醛固酮、血压、空腹血钾、空腹血糖的变化情况。结果醛固酮、血压、空腹血糖在术后明显下降,血钾水平明显上升至正常水平(P0.05)。结论伴2型糖尿病的APA所致原醛症患者行腹腔镜患侧肾上腺切除手术后高血压、低血钾、高血糖得到纠正,可改善该类型患者胰岛素抵抗现象。     

经腹腔镜切除肾上腺肿瘤5例报告

目的 探讨腹腔镜下切除肾上腺肿瘤的可行性。方法采用腹腔镜下行肾上腺肿瘤切除术治疗嗜铬细胞瘤及原发性醛固酮增多症5例。结果 平均手术时间200min平均出血量110ml，术后开始行走时间平均2d，高血压及低钾症状逐渐消失。结论 腹腔镜肾上腺切除手术具有创伤小、术后恢复快、住院时间短、术后生活质量高。     

后腹腔镜下肾上腺肿物切除术的临床价值

目的：评价后腹腔镜下肾上腺肿物切除术的临床应用价值。方法：经后腹腔镜行肾上腺肿物切除术33例,其中肾上腺皮质腺瘤15例,肾上腺皮质结节状增生3例,嗜铬细胞瘤3例,醛固酮增多症6例（腺瘤型5例,结节状增生型1例）,肾上腺囊肿3例,肾上腺节细胞神经瘤2例,髓脂肪瘤1例。结果：32例获得成功,1例中转开放手术,无严重并发症,疗效满意。结论：后腹腔镜下肾上腺手术具有创伤小、出血少、并发症少等优点,实用性强,临床疗效可靠。     

肾上腺

20050764腹膜后腹腔镜手术治疗原发性醛固酮增多症130例／张旭…∥中华外科杂志．-2004．42(18)．-1093～1095     

原发性醛固酮增多症的后腹腔镜治疗

目的：探讨腹膜后腹腔镜治疗原发性醛固酮增多症（primary aldosteronism,PHA）的应用。方法：2002年1月-2009年1月,我院对211例（男109例,女102例）PHA患者行腹膜后腹腔镜手术治疗,其中肾上腺醛固酮腺瘤（APA）113例,单侧肾上腺增生（UNAH）62例,特发性醛固酮增多症（IHA）36例。结果：211例手术均获得成功,无严重并发症发生,手术时间35～360（119．32±58．65）min,出血量10～200（52．85±49．41）ml,住院天数5～14天,术后随诊1～7（2．50±1．58）年,血压恢复正常73例,血压明显改善83例,55例患者术后仍存在高血压,总改善率为74％。结论：应用后腹腔镜治疗PHA安全、有效。     

腹腔镜手术治疗原发性醛固酮增多症227例

Objective To evaluate clinical significance of laparoscopic adrenalectomy for treatment of primary aldosteronism.Methods From Jan.1999 to Dec.2009,227 patients(92 males and 135 females)with a confirmed diagnosis of primary aldosteronism underwent laparoscopic adrenalectomy.The median age was 42years old,ranging from 22 to 69 years old.The median disease duration was 4.6 yeas,ranging from 2 months to 15 years.5 cases underwent peritoneal laparoscopic adrenalectomy and 222 cases underwent retropefitoneal laparoscopic adrenalectomy.All cases had hypokalemia,hpertension,high plasma aldosterone and low plasma rennin preoperatively.Of all the cases,there were 205 cases with aldosterone-producing adenomas among whom 80 cases underwent total adrenalectomy and 125 cases underwent partial adrenalectomy.There were 22 cases with unilateral adrenal hyperplasia and all of them underwent total unilateral adrenalectomy.Results Procedures were successfully performed in all the 227 cases.The operation duration ranged from 15 to 156 min(39 min as the median)and the blood loss ranged from 5 to 220 ml(20 ml as the median).The hospitalization time ranged from 5 to 9 days (6.9±1.2 days as the median).All the cases were followed up from 6 months to 2 years(1.2 years as the median).Postoperative potassium level resumed normal in all cases.Blood pressure resumed normal in 180 cases(80%).No adrenocortieal insufficiency and any other complication occurred.Conclusion Retropreitoneal laparoscopic partial or total adrenalectomy for treatment of primary aldosteronism is a safe and feasible procedure.     

腹腔镜手术切除巨大肾上腺肿瘤的临床探讨

目的：探讨腹腔镜手术切除巨大（直径≥8cm）肾上腺肿瘤的可行性。方法：采用经腹途径腹腔镜切除术治疗巨大肾上腺肿瘤患者6例,左侧4例,右侧2例,肿瘤最大径8．5～12cm。结果：6例腹腔镜手术均获得成功,无中转开放手术。手术时间平均120min（90～185min）,术中出血量平均150ml（50～400m1）。术后胃肠功能恢复时间1～2天,术后2～3天拔除引流管,术后住院6～lO天。随访4～24个月,未发现异常。病理检查报告肾上腺嗜铬细胞瘤2例,神经节细胞瘤1例,神经鞘瘤1例,髓性脂肪瘤2例。结论：肿瘤大小并不是选择腹腔镜手术的决定性因素。在技术娴熟的条件下,腹腔镜治疗巨大肾上腺肿瘤是安全、可行的。     

经脐单孔腹腔镜肾上腺部分切除术治疗肾上腺腺瘤（附6例报告）

目的：总结经脐单孔腹腔镜下行肾上腺部分切除术治疗肾上腺腺瘤的临床经验并探讨其可行性。方法：2009年10月～2011年1月采用自制的多通道单孔设备对6例肾上腺腺瘤患者行经脐单孔腹腔镜下肾上腺部分切除术,腺瘤直径（2．3±0．5）cm。脐部作1～2cm弧形切口,置入自制多通道单孔设备、普通腹腔镜及可弯器械,切开后腹膜,于肾上极内侧游离肾上腺肿瘤,完整切除腺瘤,尽可能保留正常肾上腺。结果：6例手术均顺利完成,手术时间（123．3±23．4）min,,出血量平均（86.5±12．4）ml。术后有1例患者血压较高,采用降压药物后控制,其余均无高血压及肾上腺危象表现,血钾均恢复至正常水平。住院时间平均3天。术后病理检查证实为肾上腺腺瘤。6例随访3～12个月,脐部切口愈合良好,无脐疝等并发症。复查B超及腹部CT均无复发。结论：采用自制的多通道设备行经脐单孔腹腔镜下肾上腺部分切除安全、可行,瘢痕隐蔽,美容效果好,是临床治疗肾上腺腺瘤的一个新选择。     

Laparoscopic Adrenalectomy for Conn's Syndrome is Beneficial to Patients and is Cost Effective in England

Purpose: Adrenalectomy has the potential to cure or improve the control of hypertension in patients with primary hyperaldosteronism due to unilateral adrenal adenoma (Conn's syndrome). This study assesses the patients' perception of, and costs associated with, laparoscopic adrenalectomy for Conn's syndrome. Materials and Methods: Clinical, radiological, operative, and pathological data were collected on patients undergoing adrenalectomy for Conn's syndrome over 8-years period in a UK tertiary referral center. Results: Thirty-eight patients (17M:21F, age 34–79 yrs, median 54 yrs) operated between Jan2005-Sept2012 had lateralization based on CT scans (n = 30) and/or MRI scans (n = 18) and confirmed on selective adrenal venous sampling (n = 25). Laparoscopic adrenalectomy was performed in all patients, with two cases requiring conversion to open operation. Median operative time was 105 min (range: 27–315). Costs were estimated as £19k for preoperative investigations, £20k for in-hospital stay, £53k for operating theatre use and £29k for disposable surgical instruments, with average £3499/patient (national tariff for adrenalectomy in 2015/2016 £3624). Follow-up at a mean of 30 months postoperatively using a visual analogue scale and a standardized questionnaire showed significantly improved quality of life (QoL) post-operatively. Majority of patients (85%) reported taking none or fewer anti-hypertensive medications (median reduction of 2 antihypertensive drugs). All patients stated that they would definitely have the operation again in preference to anti-hypertensive medications and they would recommend the operation to friends/relatives. Conclusions: Laparoscopic adrenalectomy for Conn's syndrome has a positive impact on hypertension control, leads to improved QoL and its costs are covered in the NHS financial model.     

Laparoscopic Adrenalectomy for Bilateral Pheochromocytoma: A Case Report

We report a case of bilateral (2.4-cm left and 6.5-cm right) adrenal pheochromocytoma in a 27-year-old man that was treated by laparoscopic adrenalectomy. The patient had no evidence of multiple endocrine neoplasia, type II. The left adrenalectomy was performed first, with the patient in a semilateral position, and then the patient was turned before the procedure was begun on the right side. His postoperative convalescence was uneventful, and he continues corticosteroid replacement therapy. Transperitoneal laparoscopic adrenalectomy can be a safe procedure for bilateral pheochromocytoma, if the patients are carefully selected and the procedures are performed by experienced laparoscopists.     

单切口经腹腔内途径腹腔镜下肾上腺肿瘤切除术（附10例报告）

目的：介绍单切口经腹腔内途径腹腔镜下。肾上腺肿瘤切除术的初步经验、可行性、操作难点,评价该技术在肾上腺肿瘤外科治疗中的应用前景。方法：2009年7月～2009年9月,我科采用经腹腔内途径单切口腹腔镜技术,对10例肾上腺肿瘤患者行切除术。统计数据包括年龄、性别、肿瘤大小、位置以及手术时间、术中估计出血量、术中术后并发症。自制3通道连接装置并通过长约2．5～3cm皮肤切口与腹腔内联通,手术过程中分别使用CambridgeEndo头端可弯腹腔镜器械、超声刀技术、Hem—o-lok等。结果：10例手术均取得成功,无一例增加切口辅助操作或中转开放。手术时间平均110．5min（62～148min）,术中平均出血36ml（10～60ml）,术后1天拔除胃管、导尿管,术后3天拔除腹腔引流管,术后住院时间4～6天。全部患者术中、术后均未出现血压明显波动、大出血、伤口感染等并发症。结论：单切口经腹膜内途径腹腔镜下肾上腺肿瘤切除术可行性强、安全性高;但操作难度大、学习曲线较长。因此手术器械及操作技术的不断改进有助于单切口腹腔镜在泌尿外科微创领域更为广阔的发展。     

腹腔镜肾上腺肿瘤切除术75例报告

目的探讨腹腔镜下肾上腺肿瘤切除的方法和临床应用价值.方法1999年1月～2004年6月75例患者行腹腔镜肾上腺肿瘤切除术,其中采用经腹腔途径51例和经腹膜后途径24例.结果手术时间平均为(170.16±33.81)min,术中的出血量平均为(70.82±37.15)ml.术后平均住院时间为(5.87±1.01)d.中转开放手术2例(2.67%).发生并发症4例(5.33%),分别为膈肌损伤、胰腺损伤、肠道损伤、皮下血肿各1例.结论腹腔镜下行肾上腺肿瘤切除术具有创伤小,术中出血少,术后恢复快等优点,已经成为现代治疗肾上腺肿瘤的金标准.     

Laparoscopic Adrenalectomy for Nonfamilial Adrenal Medullary Hyperplasia

Background and Objectives:

Sporadic adrenomedullary hyperplasia (AMH) is characterized by a medical history of hypertension, excessive catecholamine excretion, and histomorphometric evidence of increased adrenomedullary tissue relative to the cortex in the absence of multiple endocrine neoplasia. The aim of this study was to perform a retrospective analysis of patients after laparoscopic adrenalectomy for AMH, an early form of sporadic adrenal medulla–related endocrine hypertension, as well as to update our understanding of the clinical features and management of this clinicomorphologic entity.

Methods:

We performed a retrospective review of the medical records of patients operated on between 2007 and 2011 at Reina Sofia University General Hospital, Murcia, Spain, with a diagnosis of AMH. Patient characteristics, diagnostic studies, surgical procedures, and histologic findings were analyzed.

Results:

Seven hypertensive patients with intermittent adrenergic crises were found to have AMH (3 men and 4 women; mean age, 44 years). Catecholamine levels were increased. Radiologic studies included 1 or more of the following: magnetic resonance imaging, computed tomography, positron emission tomography imaging with fluorodeoxyglucose, dihydroxyphenylalanine–positron emission tomography–computed tomography, Octreoscan (Mallinckrodt Pharmaceuticals, St. Louis, MO, USA) and ¹²³I-metaiodobenzylguanidine scintigraphy. Laparoscopic adrenalectomy was performed in all cases. One patient underwent bilateral adrenalectomy because of persistent symptomatology after unilateral adrenalectomy. Surgery was associated with normalization of catecholamine hypersecretion and complete disappearance of symptoms, as well as the reduction or abstention of antihypertensive therapy.

Conclusions:

Sporadic AMH is a clinicomorphologic entity that may mimic pheochromocytoma clinically. Recent advances in diagnostic and surgical methods have changed the management and outcome of this unusual disease. Laparoscopic adrenalectomy may be recommended as the gold standard in the treatment of this entity. Definitive diagnosis is provided by histologic study.     

后腹腔镜肾上腺切除术（附193例报告）

目的总结后腹腔镜肾上腺切除术的手术治疗经验。方法本组193例术前均经超声、CT或CT动脉造影（CTA）等证实为肾上腺占位性病变。男70例，女123例，年龄12-74岁。右侧77例，左侧106例，双侧10例。193例患者均接受后腹腔镜肾上腺切除术。结果4例因出血中转丌放手术，其余均在腹腔镜下完成手术。平均手术时间（92±12）min，出血量（56±10）ml，术后住院天数（7．3±0．8）d。肿瘤最大径0．5～7．5cm，平均3．25cm。术后无并发症发生。随访1～24个月，2例死于肿瘤恶化。结论后腹腔镜肾上腺切除术对最大径〈8cm的肾上腺肿瘤安全、有效，创伤小、出血少、术后恢复快。     

后腹腔镜手术切除巨大肾上腺肿瘤

目的探讨后腹腔镜手术切除巨大（≥6cm）肾上腺肿瘤的可行性。方法2002年6月～2008年6月对30例直径≥6cm巨大肾上腺肿瘤行后腹腔镜切除手术。采用健侧卧位,用自制的气囊扩张后腹腔,分别在腋后线肋缘下、腋中线髂嵴上2cm及腋前线肋缘下穿刺,置入trocar。肿瘤切除后用标本袋取出肿瘤,留置引流管。结果30例后腹腔镜手术成功,无中转开放手术。平均手术时间100min（65～185min）,术中出血量平均80ml（50～250ml）。30例术后随访3～36个月,平均18.5月,无局部复发。结论对于无明显禁忌证的肿瘤,后腹腔镜手术切除巨大肾上腺肿瘤可行、安全,肿瘤直径并不是手术的决定性因素。     

Laparoscopic Surgery for Malignant Adrenal Tumors

Advances in imaging have improved early detection of primary and metastatic adrenal tumors. The laparoscopic approach, the gold standard for benign adrenal diseases, is controversial for malignant adrenal tumors. A prospective randomized study of the role of laparoscopic surgery in adrenal cancer is not feasible because of the rarity of the disease. A review of the literature demonstrates the safety and efficacy of laparoscopic adrenalectomy for solitary adrenal tumors. In primary adrenal malignancies, the laparoscopic approach should be considered cautiously, only when it can achieve complete tumor resection with an intact adrenal capsule. Conversion to an open procedure should be an early decision, prior to tumor morcellation or fracture of the tumor capsule. Patients who have local invasion, tumors that are too large, or require organ resection require an open procedure.