后腹腔镜解剖性肾上腺肿瘤切除术的治疗体会:附46例报告

目的 探讨后腹腔镜下肾上腺手术解剖定位的方法及临床应用价值.方法 对2009年9月至2011年11月本院所收46例肾上腺肿瘤患者施行后腹腔镜下切除术,其中无功能腺瘤17例,原发性醛固酮增多症13例,皮质醇增多症12例,嗜铬细胞瘤4例.常规制备后腹腔操作空间,打开Gerota筋膜,转向后壁沿腰大肌向上分离至项壁膈肌,分离前壁腹膜肾筋膜与脂肪囊间隙,沿肾上极平面横断分离寻找肾上腺,根据术中情况行肾上腺肿瘤切除或全切除术.结果 46例均成功施行腹腔镜下切除,其中1例因与下腔静脉粘连严重而部分旷置,平均手术时间83±21 min,平均出血量42±15 ml.1例(2.1％)术中胸膜穿孔,1例(2.1％)损伤下腔静脉,均在腹腔镜下完成修补.平均术后住院时间5.2 d,随访3 ～27个月,无远期并发症,46例良性肿瘤未见复发.结论 沿着正确的解剖平面寻找分离肾上腺具有快速、出血少、定位准确的优点,后腹腔镜下肾上腺手术安全、创伤小、恢复快,应为肾上腺手术的首选方法.

Retroperitoneal laparoscopic adrenalectomy for adrenal tumor: report of 46 cases

Objective To explore the value and efficacy of retroperitoneal laparoscopic adrenalectomy (RLA). Methods From September 2009 to November 2011, 46 patients with adrenal tumors underwent retroperitoneal laparoscopic adrenalectomy in our hospital,including 17 cases of nonfunctional adenoma, 13 cases of primary aldosteronism, 12 cases of hypercortisolism, 4 cases of pheochromocytoma. Retroperitoneal space was preparedconventional,open the Gerota fascia,separate from the posterior wall of the psoas major muscle to the top wall diaphragm,separate the anterior parietal peritoneum and adipose capsule on kidney clearance,separate the upper pole of kidney transversely in search for adrenal,partial or total adrenalectomy were chosen according to the intraoperative situation. Results RLA were performed successfully in 46 patients,1 cases due to inferior vena cava with severe adhesion and partial exclusion,the average operation time was 83±21 min and blood loss was 42±15 ml. during the operation. The rupture of the inferior vena cava and diaphragm occurred in one case (2.1%) and was repaired under laparoscope. The mean postoperative hospital stage was 5.2 days, The patients were followed up for 3 to 27 months,none of them had long-term complications or recurrent benign tumors. Conclusions It is important for separation along the correct anatomic plane, it has advantages of tumor locate and less blood loss. Retroperitoneal laparoscopic can be the first choice for adrenal tumors, as it is safe and effective with minimally invasive, rapid recovery, and short postoperative hospital stay.