腹腔镜手术时肾上腺血管解剖变异与处理

目的：探讨腹腔镜肾上腺手术时肾上腺血管的解剖变异与处理方法。方法：对经腹腔前入路作腹腔镜肾上腺或腺瘤切除术中，游离肾上腺发现7例肾上腺血管解剖变异并予妥善处理。结果：右侧肾上腺血管解剖变异为：中央静脉与右下肝静脉汇合后汇入下腔静脉；中央静脉汇入右肾静脉与下腔静脉的交汇处；多支中央静脉。左侧肾上腺血管解剖变异为：中央静脉与膈下静脉分别汇入左肾静脉；中央静脉与左副肾静脉汇合为主干后汇入左肾静脉。均予仔细分离血管、钛夹夹闭后切断，无一例发生意外。结论：了解并能在术中辨别肾上腺的血管解剖变异，有助于安全地进行腹腔镜肾上腺手术。

Anatomical variations in the drainage of the principal adrenal veins on laparoscopic surgery

Objective:To describe the anatomic variations and management of the drainage of the principal adrenal veins, as well as, review of previous reports.Methods:Transabdominal laparoscopic adrenal surgery were performed. The anatomical variation of the principal adrenal veins and management methods were reviewed retrorespectively.Results:On the right, the ectopic convergency with the lower right hepatic vein in 2 cases were seen. In one case the adrenal vein opened just at the confluence of the renal vein and the inferior vena cava. In 2 cases the adrenal gland was drained by 2 veins. On the left, in one case the adrenal vein and the inferior phrenic vein opened separately into the same aspect of the renal vein. The other one case the adrenal vein joined an accessory left renal vein.Conclusions:A complete understanding and recognition of the anatomic variations in the drainage of the adrenal vein is the key for the safe performance of laparoscopic adrenal surgery.