后腹腔镜治疗肾上腺较大肿瘤的经验分析

目的探讨后腹腔镜肾上腺肿瘤切除术治疗肾上腺较大肿瘤的有效性及安全性。方法回顾性选取2010年3月至2020年2月间大连市中心医院收治的1 000例肾上腺肿瘤患者,按肿瘤直径分为肾上腺较小肿瘤(直径<6cm) 665例和肾上腺较大肿瘤(直径≥6cm) 335例,术前均完善肾上腺增强CT(其中95例因过敏史行平扫CT)确定肿瘤最大直径,均采用后腹腔镜手术,评价临床价值。结果 995例患者成功完成后腹腔镜下肾上腺肿瘤切除术,5例患者中转开放手术。较小肿瘤组患者手术时间15～110min,平均40.5min;较大肿瘤组30～220min,平均78.5min。较小肿瘤组术中出血量10～220ml,平均35.5ml;较大肿瘤组50～1 200ml,平均205.5ml。较小肿瘤组术中及术后输血5例,较大肿瘤组15例。较小肿瘤组中转开放2例,较大肿瘤组3例。以上两组比较,差异均有统计学意义(P <0.05)。较小肿瘤组患者术后拔除引流管时间1～3天,平均1.55天;较大肿瘤组1～4天,平均1.59天。较小肿瘤组住院时间4～11天,平均5.1天;较大肿瘤组4～14天,平均5.25天。两组比较...

Experience analysis of retroperitoneal laparoscopic surgery for large adrenal tumors

Objective To investigate the efficacy and safety of retroperitoneal laparoscopic resection in the treatment of large adrenal tumors. Methods The clinical data of 1000 patients with adrenal tumors admitted to Dalian Central Hospital were retrospectively analyzed from March 2010 to February 2020.They were categorized into a group of small adrenal tumors(diameter < 6 cm,665 patients) and a group of large adrenal tumors(diameter ≥ 6 cm,335 patients). Preoperative adrenal enhanced CT was performed on all patients(95 of them underwent plain CT due to allergies) to identify the maximum diameter of tumors. All patients underwent retroperitoneal laparoscopic surgery and the clinical value was evaluated.Results The retroperitoneal laparoscopic surgery was successfully performed in 995 patients and 5 patients converted to open surgery. It takes 15 to 110 min(average 40. 5 min) in length for the operation in the group of small adrenal tumors and 30 to 220 min(78. 5 min) in the group of large adrenal tumors. Intraoperative blood loss was 10 to 220 ml(average 35. 5 ml) in the group of small adrenal tumors and 50 to 1200 ml(average 205. 5 ml) in the group of large adrenal tumors. Intraoperative and postoperative blood transfusion occurred in 5 patients in the group of small adrenal tumors and 15 patients in the group of large adrenal tumors. Conversion to open surgery occurred in 2 patients in the group of small adrenal tumors and 3 patients in the group of large adrenal tumors. There were significant differences in the above parameters between the two groups(all P < 0. 05). A drain was in place for 1 to 3 d(average 1. 55 d) in the group of small adrenal tumors and 1 to 4 d(average 1. 59 d) in the group of large adrenal tumors. The length of hospital stay was 4 to 11 d(average 5. 1 d) in the group of small adrenal tumors and 4 to 14 d(average 5. 25 d) in the group of large adrenal tumors. There was no statistically significant difference in the above items between the two groups(P > 0. 05). Conclusion Retroperitoneal laparoscopic resection of larger adrenal tumors takes longer operation time and had more blood loss than resection of smaller tumors and the rate of transfusions and transfusions was slightly high. However,there was no significant differences in time to postoperative drainage tube removal and length of hospital stay. This indicates that as long as the surgeon is skilled in laparoscopic operation and have relevant clinical experience,retroperitoneoscopic treatment of large adrenal tumors is safe and feasible.