后腹腔镜肾上腺肿瘤切除术疗效观察

目的观察经后腹腔镜肾上腺肿瘤切除术的临床疗效。方法对24例肾上腺肿瘤患者应用后腹腔镜肾上腺肿瘤切除术治疗,观察治疗效果及术后并发症情况。结果本组24例手术均获成功,无中转开放手术。手术时间40~118 min,失血量45~200 m L。无术中及术后输血病例,均未发生感染、肾上腺危象严重并发症。术后住院时间3~9 d,随访6个月,未见复发病例。结论后腹腔镜下手术切除肾上腺肿瘤创伤小、有效率高、恢复时间快。     

后腹腔镜肾上腺肿瘤切除术22例临床分析

目的评价经腹膜后腔行腹腔镜肾上腺肿瘤切除术的临床价值。方法对本科2002年3月至2003年6月开展的22例后腹腔镜肾上腺肿瘤切除术进行分析。22例中11例为皮质醇腺瘤，10例为醛固酮腺瘤，1例嗜铬细胞瘤。结果22例手术均获成功。手术时间60～140min，平均100min；失血量30～100mL，平均55mL，术中及术后均未输血；1例术后发生后腹膜腔血肿。结论后腹腔镜肾上腺肿瘤切除术具有对组织损伤小、出血少、术后恢复快、并发症少等优点．为非嗜铬细胞瘤肾上腺良性疾病的首选方法。     

后腹腔镜肾上腺肿瘤切除术78例报告

目的探讨后腹腔镜肾上腺肿瘤切除术的价值。方法2003年3月～2008年5月对78例肾上腺肿瘤行后腹腔镜肾上腺切除术。腰部3个trocar穿刺入路,观察镜直接推移法建立后腹膜腔,用超声刀将肿瘤切除。结果78例手术均取得成功,未输血。手术时间45～180min,平均90min。术后24h拔除引流管,术后3～5d出院。1例有局部皮下气肿,术后自行吸收,未出现其他并发症。72例术后随访3～24个月,平均10个月,36例术后3个月内血压恢复正常,7例仍需口服降压药物,肿瘤局部无复发。结论后腹腔镜肾上腺切除术具有安全、有效、创伤小、术后恢复快、住院时间短等优点,是治疗肾上腺良性肿瘤的首选方法。     

后腹腔镜肾上腺肿瘤切除术临床应用分析（附20例报告）

目的探讨后腹腔镜肾上腺肿瘤切除手术的临床经验。方法回顾性分析20例经后腹腔镜行肾上腺肿瘤切除术患者的临床资料。结果 20例均在后腹腔镜下成功完成手术,手术时间40～120分钟,平均（105±10）分钟。术中出血10～100ml,平均（85±15）ml。术后均痊愈出院。术后随访3～24个月,影像学检查2例肿瘤复发,高血压得到改善7例。结论后腹腔镜下肾上腺肿瘤切除技术成熟是治疗肾上腺肿瘤尤其是良性肿瘤的首选方法,值得临床推广。     

腹腔镜肾上腺巨大肿瘤切除术临床分析

目的:探讨腹腔镜肾上腺巨大肿瘤切除术的临床可行性及意义。方法:应用经腹腔途径为45例肾上腺肿瘤患者行腹腔镜肾上腺肿瘤切除术。术前均经B超、CT或MRI等相关影像学检查初步确诊。45例患者分为2组,32例肾上腺肿瘤直径5cm(A组),13例肿瘤直径5cm(B组)。观察2组患者手术时间、术中出血量、住院时间、中转开放率及围手术期并发症等情况。术后常规随访,定期行B超及胸片检查。结果:45例均顺利完成腹腔镜手术,平均手术时间(A组58.6min,B组86.7min)、术中平均出血(A组31.6ml,B组84.3ml)两组差异均有统计学意义(P0.01);中转开放手术A组3例(9%),B组1例(8%),两组差异无统计学意义(P0.05)。B组术中1例需输血;术后平均住院A组5.2d,B组5.7d,两组差异无统计学意义(P0.05)。术后患者均顺利康复。结论:与腹腔镜较小肾上腺肿瘤(5cm)切除术相比,腹腔镜巨大肾上腺肿瘤(5cm)切除术手术时间长,术中出血多,但住院时间及围手术期并发症无显著差异。只要术者具备娴熟的腹腔镜操作技巧及充分的临床经验,腹腔镜较大肾上腺肿瘤切除术切实可行。     

腹腔镜肾上腺切除术

目的：探讨腹腔镜肾上腺切除术的适应证和临床价值。方法：2005年1月～2008年3月对125例患者行腹腔镜下肾上腺切除术,其中经后腹腔途径110例（肿瘤直径〈5cm）,经腹途径15例（肿瘤直径5～8cm）。结果：124例手术成功,1例因术中出血中转开放。手术时间35～150min,平均50min,术中出血20～800ml,平均50ml,住院时间3～10天,平均5天。患者术前症状约于术后3个月内缓解,均无复发。结论：腹腔镜肾上腺手术具有创伤小、出血少、并发症少、恢复快、患者住院时间短的优点,是肾上腺肿瘤手术治疗的首选方法。     

后腹腔镜解剖学肾上腺肿瘤切除术的体会

【摘要】〓目的〓探讨经后腹腔镜解剖性肾上腺肿瘤切除术的手术方法和临床疗效。方法〓回顾性分析2010~2013年住院手术治疗的38例肾上腺肿瘤患者的临床资料,按既定的手术步骤施行后腹腔镜解剖性肾上腺肿瘤切除术,对临床资料、影像资料和手术录像等进行分析。结果〓38例手术均获成功,手术时间42~110 min(66±20.1),术中出血少,术后住院3~10 d,平均6.6 d。术后无严重并发症发生。术后随访6个月~2年未发现复发病例。结论〓后腹腔镜解剖性肾上腺瘤切除术,解剖层次清晰,手术操作较易掌握,疗效确切。     

单孔后腹腔镜解剖性肾上腺切除术5例报告

目的：初步探讨单孔后腹腔镜肾上腺切除术的临床可行性和安全性。方法：2009年7～8月采用单孔后腹腔镜肾上腺切除术治疗肾上腺肿瘤患者5例,其中男性患者2例,女性患者3例,平均年龄（58．4±3．6）岁,平均体重指数（25．9±2．6）;左侧3例,右侧2例;肾上腺皮质无功能腺瘤3例,肾上腺醛固酮瘤2例。行肾上腺全切术1例,肾上腺肿瘤切除术4例。3例患者术后留置引流管,2例患者未留置引流管结果：5例单孔后腹腔镜肾上腺切除术均顺利完成,手术时间35～60min,平均（51．2±11．2）min;肿瘤最大径1．0～3．5cm,估计出血量5～10ml,平均（8．0±2．7）ml,无中转开放及转为标准三孔腹腔镜手术,术中发生1例腹膜破裂,给予修补,无其他并发症发生,短期随访无术后并发症发生。结论：初步结果显示了单孔后腹腔镜肾上腺切除术具有良好的安全性和可行性,但其临床治疗效果尚需大样本中远期随访和对照研究予以证实。     

后腹腔镜解剖性肾上腺切除术

目的介绍后腹腔镜解剖性肾上腺切除术的手术方法及临床效果。方法2000年2月至2005年10月,对800例患者采取后腹腔镜解剖性肾上腺切除术。常规制备后腹腔操作空间。切开Gerota筋膜后,按顺序分别进入3个相对无血管解剖层面进行分离。第一分离层面位于肾脏内上方脂肪囊与前层Ger0ta筋膜之间,此层面可以在手术初期快速找到肾上腺;第二分离层面位于肾外上方脂肪囊与后层Gerota筋膜之间;第三分离层面位于肾上腺下方与肾上极之间。最后处理肾上腺中央静脉。依术前诊断和术中情况选择行肾上腺全切或次全切术。结果除1例嗜铬细胞瘤(肿瘤直径7.8 cm)患者因肾上腺肿瘤与肝脏及下腔静脉粘连紧密行中转开放手术外,全部手术均成功完成。平均手术时间(45±19)min,平均术中出血量(25±11)ml。恢复饮食和下床活动时间分别为1.2 d和1.0 d。12例(1.5%)出现术后皮下气肿、皮下血肿或切口感染。除6例特发性肾上腺增生患者术后1年高血压复发外,其余患者临床症状均消失或明显好转。结论后腹腔镜解剖性肾上腺切除术解剖层次清楚,术野清晰.疗效确切,为肾上腺外科疾病的治疗提供了更加安全的选择。     

后腹腔镜肾上腺肿瘤切除术

目的：探讨后腹腔镜切除肾上腺肿瘤手术的应用价值及腹膜后腔建立方法的改进。方法：回顾性分析我院2003年10月～2006年3月采用后腹腔镜手术治疗102例肾上腺肿瘤患者的临床资料,其中肾上腺嗜铬细胞瘤切除29例,原醛症肾上腺腺瘤切除或肾上腺切除52例,皮质醇症肾上腺腺瘤切除21例。结果：102例全部手术成功。手术时间60～130min,平均90min;建立腹腔后间隙时间3～7min,平均4min;术中平均失血量80ml。术后平均住院5天。结论：后腹腔镜手术安全,对患者创伤小,术后肠道功能恢复快,伤121愈合早。新的后腹腔间隙建立方法有效、快捷、方便,值得推广。     

Retroperitoneal approach in laparoscopic adrenalectomy

Recently, the retroperitoneal laparoscopic approach has been described as advantageous in avoiding the respiratory and hemodynamic effects of CO₂ pneumoperitoneum and giving direct access without the need to move abdominal organs. Forty-two laparoscopic adrenalectomies (LpA) were performed in 36 patients with a variety of adrenal disorders, including 9 patients with nonfunctioning tumors, 11 patients with aldosterone adenoma, 10 patients with Cushing's adenoma, and 6 patients with Cushing's disease. Twenty-two adrenalectomies were performed using the transperitoneal approach (TLpA), and 20 via the retroperitoneoscopic approach (RLpA). Arterial blood samples, mean arterial pressure, heart rate, and clinical parameters were evaluated. At the end of the operation, the PaCO₂, PetCO₂, and base deficit all increased significantly in both retroperitoneal and transperitoneal CO₂ insufflation compared with basal values. Arterial pH decreased significantly in both TLpA and RLpA groups. All clinical parameters evaluated (operation time, analgesic dosing requirements, hospital stay, and the days until return to normal activity) were similar in the TLpA and RLpA approaches. Two patients in the TLpA (10.5%) group and two patients in the RLpA (10%) group needed conversion to open surgery. This study shows the safety and efficacy of laparoscopic adrenalectomy via the transperitoneal or retroperitoneal route in patients with a variety of adrenal disorders. The retroperitoneoscopic approach could be the primary choice in patients with previous abdominal surgery. Received: 3 April 1997/Accepted: 26 August 1997     

经腹膜后入路腹腔镜下肾上腺血管瘤切除术的临床经验分享

目的:总结经腹膜后入路腹腔镜下肾上腺血管瘤切除术的手术经验。方法:回顾分析2014年5月至2016年12月收治的5例术后病理证实肾上腺血管瘤患者的临床资料,其中男1例,女4例,中位年龄42(27~67)岁;中位肿瘤直径3.5(2.4~4.5)cm,左侧2例,右侧3例;术前CT提示5例肿瘤均为囊实性、边界清,2例肿瘤内可见明显多处钙化。5例患者均行后腹腔镜肾上腺肿瘤切除术。结果:5例手术均顺利完成,无一例中转开放,术中、术后无严重并发症发生。中位手术时间65(50~90)min,术中出血量<50 mL,术后中位住院时间4(3~6)d;术后病理结果提示,5例均为肾上腺血管瘤;术后中位随访时间15(9~36)个月,患者恢复情况良好,无激素不足等症状出现,随访期间均未见肿瘤局部复发。结论:肾上腺血管瘤是较罕见的肾上腺良性肿瘤,术前影像学检查明确困难,术后病理为金标准。后腹腔镜肾上腺肿瘤切除术治疗肾上腺血管瘤可行、安全、有效,值得临床推广应用。     

后腹腔镜下肾上腺肿物切除术的临床价值

目的：评价后腹腔镜下肾上腺肿物切除术的临床应用价值。方法：经后腹腔镜行肾上腺肿物切除术33例,其中肾上腺皮质腺瘤15例,肾上腺皮质结节状增生3例,嗜铬细胞瘤3例,醛固酮增多症6例（腺瘤型5例,结节状增生型1例）,肾上腺囊肿3例,肾上腺节细胞神经瘤2例,髓脂肪瘤1例。结果：32例获得成功,1例中转开放手术,无严重并发症,疗效满意。结论：后腹腔镜下肾上腺手术具有创伤小、出血少、并发症少等优点,实用性强,临床疗效可靠。     

Sub-mesocolic access in laparoscopic left adrenalectomy

Background This article reports an alternative laparoscopic access to left adrenal gland.Methods From January 1994 to August 2004, 209 laparoscopic adrenalectomies were performed in our Department. Indications were Conn adenoma (55 cases), incidentaloma (64), Cushing adenoma (45), pheochromocytoma (32), adreno-genital syndrome (two), mielolipoma (two), and metastatic mass(nine). Of 209, in 12 cases the left adrenalectomy was performed through a submesocolic access (seven pheochromocytoma, two incidentaloma, two Cushing adenoma, one Conn adenoma,). The identification and closure of the adrenal vein with minimal gland manipulation resulted the main benefit of this approach. Moreover, the adrenalectomy was performed with minimal anatomical dissection.Results No mortality or major complications occurred. During the operation, the blood pressure and cardiac rhythm were significantly more stable, in the group of patients who underwent a left adrenalectomy by the submesocolic approach compared to the anterior or flank lateral transperitoneal group.Conclusions Left adrenal lesions, as selected cases of pheochromocytoma, can be safely treated by laparoscopic submesocolic access.     

后腹腔镜治疗肾上腺疾病43例报告

目的:探讨后腹腔镜手术切除肾上腺病变的适应证、手术方法及效果。方法:对43例肾上腺病变患者行后腹腔镜肾上腺病变切除术。肾上腺肿瘤39例(库兴综合征14例,嗜铬细胞瘤6例,原发性醛固酮增多症11例,无功能腺瘤7例,肾上腺神经节细胞瘤1例),肾上腺囊肿4例。结果:43例手术除1例改为开放手术外,余均获得成功,手术时间为35~60min,平均为50min。术中出血70~130ml,平均95ml。患者术后第2天下床活动并进流质饮食;引流管于术后2~4天拔除,无大出血、皮下气肿等并发症;平均住院时间9天。问卷调查,患者均于术后7~20天(平均14天)恢复正常生活。结论:后腹腔镜肾上腺切除术是一种微创、安全、有效、恢复快的术式,应成为肾上腺良性疾病的首选手术方法。     

后腹腔镜技术治疗肾上腺肿瘤53例报告

Objectives To summarize the clinical experience of retroperitoneal laparoscopic adrenalectomy for adrenal tumor and facilitate the clinical application.Methods From June 2002 to October 2009,S3 caws of adrenal tumor were treated with retroperitoneal laparoscopic adrenalectomy,including 19 cases of primary aldosteronism,8 cases of Cushings syndrome,9 cases of pheochromocytoma,14 cases of nonfunctional adrenal adenoma,2 cases of adrenal cyst,1 case of adrenal paraganglioma.B ultrasound and CT/MRI were used to diagnose all patients.33 tumors were on the left side and 20 on the right.The size of the tumors ranged from 1.2 to 7.0cm(mean,2.2cm).Results 49 surgeries were successfully completed.4 surgeries converted to open surgeries.The mean of operating time was 92(56～220) min.The mean of estimated blood loss was 55 (20～300 ) ml.The mean of postoperative hospitalization was 7(4～12) days.There was no serious complication during perioperative period.Conclusions Retroperitoneal laparoscopic adrenalectomy for adrenal tumor is safe and effective with the advantages of minimal invasion,quick recovery and few complications.It should be considered as the first choice for treating benign adrenal diseases.     

后腹腔镜技术治疗肾上腺肿瘤53例报告

Objectives To summarize the clinical experience of retroperitoneal laparoscopic adrenalectomy for adrenal tumor and facilitate the clinical application.Methods From June 2002 to October 2009,S3 caws of adrenal tumor were treated with retroperitoneal laparoscopic adrenalectomy,including 19 cases of primary aldosteronism,8 cases of Cushings syndrome,9 cases of pheochromocytoma,14 cases of nonfunctional adrenal adenoma,2 cases of adrenal cyst,1 case of adrenal paraganglioma.B ultrasound and CT/MRI were used to diagnose all patients.33 tumors were on the left side and 20 on the right.The size of the tumors ranged from 1.2 to 7.0cm(mean,2.2cm).Results 49 surgeries were successfully completed.4 surgeries converted to open surgeries.The mean of operating time was 92(56～220) min.The mean of estimated blood loss was 55 (20～300 ) ml.The mean of postoperative hospitalization was 7(4～12) days.There was no serious complication during perioperative period.Conclusions Retroperitoneal laparoscopic adrenalectomy for adrenal tumor is safe and effective with the advantages of minimal invasion,quick recovery and few complications.It should be considered as the first choice for treating benign adrenal diseases.     

机器人辅助后腹腔镜肾上腺醛固酮瘤切除术

目的探讨机器人辅助后腹腔镜下治疗肾上腺醛固酮瘤的临床应用及手术疗效。 方法回顾性分析首都医科大学附属北京安贞医院泌尿外科自2015年1月至2018年1月行机器人辅助后腹腔镜肾上腺醛固酮瘤切除术患者的临床资料及术后随访结果。 结果21例患者,其中男性7例、女性14例,左侧12例、右侧9例,均行保留肾上腺手术,手术均获得成功,手术时间(110.54±29.21)min,出血量(25.12±10.01) ml,住院时间5.15～1.21 d,术后无严重并发症发生。术后随访时间0.5～2年,比较患者术前与术后1年的血压、血钾、血醛固酮/肾素、降血压药物种类等指标,各项指标均得到明显缓解,差异具有统计学意义(P <0.05),21例患者中血压恢复正常6例(28.6%),15例(71.4%)术后仍持续高血压,其中13例(86.7%)患者减少降血压药物使用。 结论机器人辅助后腹腔镜肾上腺醛固酮瘤切除术安全有效,是肾上腺原发性醛固酮增多症外科手术治疗的较好选择。