后腹腔镜肾上腺手术401例

目的探讨后腹腔镜肾上腺肿瘤切除的方法和临床应用价值。方法2002年8月～2007年12月，行后腹腔镜肾上腺肿瘤切除术401例，其中无功能腺瘤151例，原发性醛固酮增多症139例，皮质醇增多症37例，嗜铬细胞瘤19例，髓样脂肪瘤13例，其他42例。结果5例中转开放手术，其中1例瘤体过大腹腔镜操作困难，2例肿瘤与下腔静脉粘连紧密，2例出血；余396例手术成功，手术时间30～270min，平均105min，术中失血20～1000ml，中位数45ml，2例术中各出血1000、800ml，输红细胞2U。术中下腔静脉破裂1例，膈肌破裂1例，均在腹腔镜下完成修补。364例随访1～64个月，平均23．9月，无远期并发症，361例良性肿瘤未见复发。结论后腹腔镜肾上腺肿瘤切除术安全，有效，创伤小，恢复快，应为肾上腺良性疾病的首选治疗方法。

Experience on Retroperitoneal Laparoscopic Adrenalectomy in 401 Cases

Objective To explore the value and efficacy of retroperitoneal laparoscopic adrenalectomy. Methods From August 2002 to December 2007, a total of 401 cases of retroperitoneal laparoscopic adrenalectomy were performed in our hospital. Among the cases, nonfunctioning adenoma was diagnosed in 151 patients; hyperaldosteronism was detected in 139, Cushing＇s syndrome in 37, pheochromocytoma in 19, myelolipoma in 13, and other diseases were found in 42. Results Among the cases, 5 were converted to open surgery because of difficulties in the operation due to a huge tumor （ 1 ） , extensive adhesion between the tumor and the inferior vena cava （2） , or massive bleeding （2）. The other 396 cases of retroperitoneal laparoscopic adrenalectomy were completed successfully with a mean operation time of 105 minutes （30 to 270 minutes） , and a median blood loss of 45 ml （20 to 1000 ml）. Two of these patients had massive hemorrhage （ 1000 and 800 ml respectively） , and received red blood cells transfusion （2 U） during the surgery. The rupture of the inferior vena cava or diaphragm occurred in two cases, and was repaired under a laparoscope. Follow-up was available for up to 1 to 64 months （ mean 23.9） in 364 patients; none of them had long-term complications or recurrent benign tumors. Conclusions Retroperitoneal laparoscopic adrenalectomy should be used as the first choice for benign adrenal neoplasms, since the procedure is safe, effective, and minimally invasive, and the patients recovery quickly after the surgery.