肾上腺肿物切除术后再行腹腔镜肾上腺手术

目的：总结既往有肾上腺手术史者再行腹腔镜肾上腺手术的经验。方法：2005年5月～2007年3月采用腹腔镜经腹腔途径对3例肾上腺肿物切除术后患者再行腹腔镜肾上腺肿物切除术。3例原发性醛固酮增多症患者均为女性，平均48岁（35～56岁），左侧1例，右侧2例，肿瘤平均直径1．4cm（1．2～2．0cm），2例曾行腹腔镜经后腹腔肾上腺肿物切除，1例曾行经腰切口开放’肾上腺肿物切除。观察手术时间、术中出血量、住院天数、并发症及手术效果。结果：3例手术均顺利完成。平均手术时间90min（75～110min），术中平均出血量20ml（10-30ml）。平均住院时间5天（4～6天），术中术后无并发症发生。随访8～25个月肿瘤无复发。结论：对于有肾上腺手术史者再行腹腔镜肾上腺手术难度增加，但腹腔镜再次手术是可行有效的。

Subsequent Laparoscopic Adrenalectomy for Patients with Previous Adrenal Surgery(Report of 3 Cases)

Objective：To summarize the experience of subsequent laparoscopic adrenaleetomy for patients with previous adrenal surgery. Methods：From May 2005 to March 2007, 3 patients were performed laparoscopic adrenaleetomy after adrenal tumor resection. All the patients with primary aldosteronism were women, including 1 left side patient and 2 right side patients. The mean patient age was 48 years （range 35-56 years）. 2 patients had previous retroperitoneal laparoscopic partial adrenalectomy and 1 patient had previous open partial adrenalectomy through lumbar incision. The operative time, estimated blood loss, hospital stay, complications and effect of su〉 gery were recorded. Results：The procedure was successfully performed in all patients. The mean operative time was 90 min （range 75-110 min）. The average estimated blood loss was 20 ml （range 10-30 ml）. The mean hospital stay was 5 d （range 4-6 d）. No complication occurred. During a follow up of 8 25 months, no tumor recurrence was found. Conclusions： Although subsequent laparoscopic adrenalectomy greatly increases the difficulties in operation for the patients with previous adrenal surgery, the subsequent transperitoneoscopic approach to the adrenal is feasible and effective.