36例腹膜后腹腔镜肾上腺肿瘤手术

目的探讨腹膜后腹腔镜肾上腺肿瘤手术的临床经验。方法2009年3月至2011年10月，对商丘市第一人民医院36例肾上腺肿瘤行腹膜后腹腔镜切除术。腰部3个trocar穿刺入路，气囊法建立后腹膜腔，完整切除肿瘤。结果肾上腺皮质腺瘤19例，嗜铬细胞瘤14例，肾上腺囊肿2例，肾上腺皮质腺癌1例。34例手术成功，未输血。手术平均时间90（45～180）min。术中平均出血量76（30—700）ml。术后2d拔除引流管，术后3—5d出院。2例（1例瘤体与腔静脉等紧密粘连，1例瘤体约6．0cm）中转开放手术。术后平均随访12（3—24）个月，1例有局部皮下气肿，自行吸收；30例术后3个月内血压恢复正常，6例（含中转手术2例）仍需口服降压药物，无肿瘤局部复发和死亡病例。结论后腹腔镜肾上腺切除术具有创伤小、术后恢复快、住院时间短等优点，是一种安全、有效的治疗肾上腺良性肿瘤的方法。

Retroperitoneal laparoscopic adrenalectomy :36 cases

Objective To evaluate the value of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors. Methods From Mar. 2009 to Oct. 2011,36 patients with adrenal tumors received retroperitoneal laparoscopic adrenalectomy in the First People＇ s Hospital of Shangqiu. During the operation, 3 trocars were introduced into the lumbar region to establish retroperitoneal space. Afterwards, the tumor was removed by using a harmonic scalpel. Results The procedures were successfully completed in 19 cases of adrenocortical adenoma, 14 cases of pheoehromocytoma, 2 cases of adrenal cyst and 1 case of adrenocortical carcinoma without blood transfusion. The median operation time was 90 min, ranging from 45 min to 180 rain. The median intraoperative blood loss was 76 ml, ranging from 30 ml to 700 ml. Drainage tubes were removed 2 days after the operation and the patients were discharged from hospital 3 to 5 days after operation. 2 cases were converted to open surgery （ one because of the adhesion between the tumor and vena cava, the other because of the size （about 6.0 cm） of the tumor）. The median follow-up time was 12 months, ranging from 3 to 24 months. One patient showed regional subcutaneous emphysema after the surgery and was cured spontaneously. The patients were followed up for 3 to 24 months with the medium of 12 months. Normal blood pressure was achieved in 30 patients in 3 months, while oral antihypertension drugs were still needed for the other 6 patients （2 patients converted to open surgery included） . No regional recurrence or death happened during the follow-up. Conclusion Retroperitoneal laparoscopic adrenalectomy can be a safe and effective choice for adrenal tumors, with advantages of small trama, quick recovery, short postoperative hospital stay etc.