腹腔镜肾上腺切除术和开放肾上腺切除术治疗肾上腺巨大良性肿瘤的比较

目的：了解腹腔镜肾上腺切除术（1aparoscopicadrenalectomy，LA）和开放肾上腺切除术（openadre—nalectomy，OA）治疗肾上腺巨大（〉6cm）良性肿瘤的差别。方法：分析2009年1月～2011年12月手术治疗的50例肾上腺巨大良性肿瘤的l陆床特点。其中LA组26例，OA组24例。比较两组年龄、肿瘤大小、手术时间、术中出血量、住院时间、切口长度；LA组嗜铬细胞瘤切除6例，OA组嗜铬细胞瘤切除7例，比较两者术中血流动力学变化。结果：术后病理为肾上腺腺瘤2例，节细胞神经瘤10例，嗜铬细胞瘤13例，髓样脂肪瘤19例，肾上腺囊肿伴出血3例，神经鞘膜瘤2例，肾上腺巨淋巴结增生（Castleman病）1例。LA组和OA组比较，平均年龄分别为（45．3±15．6）岁和（52．2±13．2）岁（P=0．069）；肿瘤直径分别为（7．75±1．26）cm和（8．38±1．96）cm（P=0．098）；平均手术时间分别为（65．2±23．4）min和（126．9±32．5）min（P〈0．01）；出血量分别为（,54．1±19．5）m1和（205．0±49．6）ml（P〈O．01）；住院时间分别为（4．8±1．6）d和（7．6±2．1）d（P〈0．01）；切口长度分别为（7．56±2．06）cm和（18．28±3．25）cm（P〈O．01）。LA组无一例发生手术相关并发症或中转开放；（）A组冈肾血管损伤行一侧肾切除1例。LA组切除嗜铬细胞瘤术中最高收缩压和心率低于OA组（P〈O．05）。术后随访3～26个月，肿瘤无复发。结论：尽管I。A需延长切口取出肿瘤，但与OA相比，切除肾上腺巨大良性肿瘤仍具有手术时间短、出血少、创伤小、恢复快等优势。

Comparison of laparoscopic adrenalectomy and open adrenalectomy for large benign adrenal tumors

Objective： To compare laparoscopic adrenalectomy （LA） with open adrenalectomy （OA） /or benign adrenal masses larger than 6 cm. Method： The data of 50 patients with large adrenal benign masses （〉6 cm） from Jan. 2009 to Dec. 2011 were reviewed. Twenty-six patients underwent LA and 24 for OA. The tumor size, the age of patients and operative time, volume of blood loss during operation, hospital stay, length of incision and the hemodynamic variation of pheochromocytoma underwent two types of operations were analyzed. Result： His- topathological examination confirmed adrenal adenoma in two, ganglioneuroma in ten, pheochromocytoma in 13, myelolipoma in 19, adrenal cyst combined with hemorrhage in three, schwannoglioma in two, Castleman disease in one. The meanage, size of the tumor were （45.3±15.6） years and （52.2±13.2） years （P=0.069）, （7.75±1.26） cm and （8.38±1.96） cm （P=0. 098） in LA and OA group respectively. The mean operative time, blood loss, hospital stay, and length of incision were （65.2±23.4） min and （126.9±32.5） min （P〈0.01）, （54. 1± 19.5） mland （205.0±49.6） ml（P〈0.01）, （4.8±1.6） dand （7.6±2.1） d （P〈0.01）, （7.56±2.06） cmand （18.28±3.25） cm （P〈0.01） in two groups respectively. There was no intraoperative complication and conver- s{ons to an open procedure in I.A group. An unilateral nephrectomy was needed in one case with Castleman disease because of intraoperative injury of renal hilum in OA group. There was no recurrence in either group during fol- low-up period of three to 26 months. The average peak intraoperative blood pressure and heart rate were lower in IrA group than those in OA group （P〈0. 05）. Conclusion： Compared with open adrenalectomy, laparoscopic adrenalectomy is a safe and effective treatment for large benign adrenal masses because of its successful outcome in terms of operative time, blood loss, hospital stay despite of extended incision.