巨大肾上腺肿瘤手术方法探讨(附35例报告)

目的:提高巨大肾上腺肿瘤手术水平。方法:回顾性总结了经手术治疗的35例巨大肾上腺肿瘤患者临床资料。结果:行腹部正中切口8例,腹部右侧L形切口7例;左侧腹部胸膜外胸腹联合切口5例,左侧胸腹联合切口3例;肋间切口12例,其中第10肋间切口8例,11肋间切口4例。肿瘤位于右侧肾上腺21例;位于左侧肾上腺14例。肿瘤直径8～35cm,平均15.8cm,重量75～2600g,平均550g。术后病理提示皮质癌5例;嗜铬细胞瘤(pheo)20例;恶性pheo4例;恶性纤维组织细胞瘤1例;节神经细胞瘤1例;髓样脂肪瘤1例;畸胎瘤1例;畸胎肉瘤1例;高分化脂肪肉瘤1例。结论:①周密充分的药物准备以及合理完整的影像学定位资料,是术前处理的关键。②大部分巨大肾上腺肿瘤拟用经腹切口,必要时右侧肾上腺肿瘤可行右侧腹部L形切口;左侧肾上腺肿瘤可用腹部胸膜外胸腹联合切口,或胸腹联合切口。③术后注意生命体征观察,防止稀释性贫血、肾上腺皮质功能不全以及低血糖的发生。

Clinical procedures for large tumors in adrenal

Objective:To probe into the treatment of large tumors in adrenal.Methods:The clinical data of 35 cases of large tumors in adrenal that underwent surgical excision were reviewed.Results:In 8 patients,the tumor was removed by abdominal median incision and 7 by abdominal right L-shape incision,5 by left dorsolumbar flap incision,3 by left abdominothoracic incision,12 by intercostal incision 8 at 10 th rib and 4 at 11 th rib.21 cases were situated in the right adrenal and 14 cases were situated in the left.The average diameter of the growth was 15.8 cm(7-35 cm)and the average weight was 550g(75-2 600 g).The postoperative pathology confirmed that cortical carcinoma was found in 5 cases and pheochromocytoma in 20 cases,malignant pheochromocytoma in 4 cases,malignant fibrous histiocytoma in 1 case,neurocytoma in 1 case,myelolipoma in 1 case,dysembryoma in 1 case,dysembryo-sarcoma in 1 case,well-differentiated liposarcoma in 1 case respectively.Conclusions:Appropriate medical preparation and overall data of imaging is the key before surgery.Abdominal incision are suitable for the large tumors in adrenal,right L-shape incision and left abdominalthoracic incision or dorsolumbar flap incision can be also performed.Monitoring for hypoglycemia and insufficiency of adrenal cortex,dilution anemia have to be awared of after surgery.