巨大肾上腺肿瘤开放手术治疗的临床经验

目的：总结经腹腔途径开放手术治疗巨大肾上腺肿瘤（≥10cm）的临床经验，提高围手术期的安全性。方法：回顾性分析13例巨大肾上腺肿瘤患者的临床资料，术前完善相关生化指标和影像学检查，充分术前准备，采取经腹腔途径开放手术方案，术中配合使用徽创器械（钛夹、Hem-o-lock、超声刀）完整切除肿瘤。结果：本组手术均顺利完成，肿瘤最小为直径1．1．2cm，最大为17．0cm，平均13．6cm。平均手术时间126（100-185）min，术中出血量平均280（150-500）ml。无严重围手术期并发症，术后随访6-18个月，1例肺部转移，余未见肿瘤局部复发或转移。结论：巨大肾上腺肿瘤经腹腔手术完整切除是其有效的治疗手段，手术风险大，并发症多，完善术前检查，充分评估手术风险，积极的术前准备，术中仔细操作等均是保障围手术期安全的关键。

Clinical experience of open excision for huge adrenal neoplasms

Objective： To summarize our experience in the transperitoneal surgery treatment on the patientswith huge adrenal neoplasms（≥10 cm） for improving the perioperative safety. Method：Clinical data of 13 cases of patients with huge adrenal neoplasms were restrospectively reviewed. Sufficient preparation for paients were per- formed before the operations. All patients were underwent transperitoneal open tumor excision. The minimally in- vasive equipments such as titanium clip, Hem-o-lock and ultrasound knife were applied in the operation. Result：All operations were finished successfully. The mean diameter of tumor was 13. 6 cm（range, 11.2 to 17.0 cm）. Mean operative time was 126 rain（range, 100 to185 rain）, and mean estimated blood loss was 280 ml（range, 150 to 500 ml）. No major complication occurred during the perioperation. During the 6-18 mounths follow-up, 1 case was found pulmonary metastases. Coadasion：Transperitoneal open tumor excision is an effective treament for patients with huge adrenal tumors. However,it is a complicated surgical operation with high risk and many complications. Completely preoperative inspect, sufficient preparation and carefully operation for tumor are the key points to safe- ty during the perioperation.