开放手术切除巨大肾上腺肿瘤44例报告

目的 总结开放手术切除巨大肾上腺肿瘤的经验,提高手术安全性及有效性.方法巨大肾上腺肿瘤患者44例,肿瘤长径9～34 cm,平均13 cm.均行开放手术切除,常规准备自体血液回收.对临床资料特点,术中、术后并发症及手术切除效果进行分析. 结果 5例采用11肋间切口,32例采用肋缘下经腹斜切口,7例因肿瘤巨大或侵犯腔静脉壁行胸腹联合切口.44例中恶性肿瘤27例(61.4%),肿瘤呈浸润性生长,3例侵犯肝脏,6例合并腔静脉瘤栓,其中2例因肿瘤侵犯腔静脉行人工血管置换术,3例术中使用体外循环.41例(93.2%)术中出血100～3000 ml,平均1309 ml,20例(45.5%)术中使用自体血液回收.手术并发症:术中膈肌损伤1例,胸膜损伤1例,肿瘤侵犯黏连致术中大出血3例,出血量超过15 000 ml.术后发生腹腔感染2例.无围手术期死亡患者.42例(95.5%)根治性切除肿瘤,2例因肿瘤黏连大出血致肿瘤残留.结论 巨大肾上腺肿瘤手术难度大,出血多,风险高,手术切口的合理选择、自体血液回收的应用、多学科的协作及丰富的手术经验对提高手术切除率及安全性至关重要.

Open surgery for huge adrenal tumors: clinical report of 44 cases

Objective To summarize the experience in open surgery for huge adrenal tumors in order to improve its safety and efficiency of this complicated surgical procedure. Methods Fortyfour consecutive patients with huge adrenal tumors underwent open surgery with mean long tumor diameter of 13 cm (9-34 cm), and autologous blood transfusion was prepared in routine. It was analyzed retrospectively for clinical data, perioperative complications and the effective and safety results of this procedure. Results The incision was oblique in lumbar region in 5 cases, subcostal unilaterally in 32 cases and abdomino-thoracic joint in 7 cases. There were 27 malignant tumors (61.4%) in 44 cases, 3 with hepatic invasion, 6 with thrombi extending into inferior vena cava, among which 2 needed translocation of artificial blood vessels and 3 needed cardio-pulmonary bypass. The mean blood loss was 1309 ml (100-3000 ml) in 41 cases(93.2%)and the autologous blood transfusion was used in 20 case (45.5%). There were 1 diaphragmatic injury, 1 pleura injury, 3 hemorrhage in large amount more than 15 000 ml and 2 peritoneal cavity infection.There were no perioperative deaths and 42 tumors (95.5%) were curatively resected. Conclusions Open surgery for huge adrenal tumors is a complicated surgical technique with high risk and large amount of blood loss. The key points to success are proper selection of incision, routine autologous blood transfusion, perfect surgical skills and good cooperation between different specialties.