复发肾上腺肿瘤患者行经腹腹腔镜手术的技巧

目的 探讨经腹腹腔镜手术治疗复发肾上腺肿瘤的手术疗效和技巧. 方法 我院于2013年10月至2017年1月采用腹腔镜技术治疗复发肾上腺肿瘤患者12例,其中男5例,女7例.年龄25~68岁,平均51岁.术前CT提示左侧7例,右侧5例.12例中原发性醛固酮增多症8例、嗜铬细胞瘤2例、肾上腺皮质癌2例.除1例肾上腺皮质癌患者既往接受左侧开放11肋间切口术式外,其余11例患者既往均为后腹腔镜手术入路.本次手术均在全麻下进行,12例患者均采用健侧卧位经腹腔途径结肠旁沟入路,8例采用普通腹腔镜肾上腺切除术,4例采用机器人辅助腹腔镜肾上腺切除术. 结果 12例手术均获成功,无1例中转开放.肾上腺肿瘤大小1.0~8.0 cm,平均3.5 cm.手术时间25~93 min,平均48 min.术中出血量30~200 ml,平均115 ml,术中均未输血.术后住院时间4~10 d,平均5.7 d.术后随访2~38个月,仅1例肾上腺皮质癌患者术后1年出现复发,其余患者均未见肿瘤复发. 结论 复发肾上腺肿瘤因原手术区域粘连、解剖异常等具有一定的手术难度,再次手术时选择不同的手术径路,可最大限度避开原手术粘连部位.对于体积较大的复发肾上腺肿瘤,机器人辅助腹腔镜手术不失为一种创伤小、安全可靠、疗效确切的手术方法.

Surgical technique of transperitoneal laparoscopic surgery for patients with recurrent adrenal tumors

Objective To discuss the feasibility, efficacy and surgical technique of laparoscopy in the treatment of recurrent adrenal tumors.Methods 12 patients with recurrent adrenal tumors underwent laparoscopic surgeries from October 2013 to January 2017.5 patients were male and 7 patients were female.Preoperative CT scan indicated that tumor was located in the left side in 7 patients, and located in the right in 5 patients.Of the 12 recurrent adrenal tumors 8 were aldosteronomas, 2 were pheochromocytomas and 2 were adrenal cortical carcinomas.1 patient with adrenal cortical carcinoma had received open surgery with 11th intercostal incision, while the rest patients had received retroperitoneal laparoscopic surgeries.All the surgeries were performed by lateral transperitoneal approach through the paracolic sulcus.General anesthesia was used in all cases.Conventional laparoscopic adrenalectomy (LA) were applied in 8 patients, and robotic adrenalectomy (RA) were applied in 4 patients.Results All the operations were successfully performed without conversion to open surgery.The diameters of the tumors were ranged 1.0 to 8.0 cm, with an average of 3.5 cm.The operation time was 25 to 93 min, with an average of 48 min.The estimated blood loss was 30 to 200 ml, with an average of 115 ml.No transfusion was needed during the surgeries.The length of postoperative hospitalization time was 4 to 10 d, with an average of 5.7 d.Recurrence occurred in 1 patient with adrenal cortical carcinoma in 1 year follow-up and no recurrence was found in the rest of the patients during the follow-up of 2 to 38 months.Conclusions The recurrent adrenal tumors have certain difficulty in laparoscopic operations due to the original operation and anatomical abnormalities.Using different surgical approaches can avoid these problems.For patients with large recurrent adrenal tumors, DaVinci robot assisted laparoscopic surgery may have the advantage of more delicate and safer manipulation and less complications, which deserves widely applied.