经腹、经后腹腔途径腹腔镜肾上腺肿瘤切除术(附56例报告)

目的 总结经腹腔、经后腹腔途径腹腔镜肾上腺肿瘤切除术的临床经验. 方法 2001年12月～2004年12月,我院施行腹腔镜肾上腺切除术56例.采用经腹腔途径肾上腺肿瘤切除术10例,腹部取3个trocar 穿刺入路,切开侧腹膜和肾周筋膜,在肾上极内上方分离肾上腺或瘤体,结扎速结合超声刀将肿瘤切除.经后腹腔途径切除肾上腺肿瘤46例,腰部取3个trocar 穿刺入路,用自制的气囊扩张后腹腔,切开肾周筋膜,在肾上极内上方分离肾上腺或瘤体,结扎速结合超声刀将肿瘤切除. 结果 10例经腹腔途径中3例因腹腔广泛粘连中转开放手术,46例经后腹腔途径中1例因下腔静脉损伤大出血中转开放手术.余52例术中出血量20～200 ml,平均70 ml,均未输血.手术时间40～200 min,平均110 min.术后住院3～8 d,平均5.4 d.52例随访6～36个月,平均8个月,未见肿瘤复发和转移. 结论 腹腔镜肾上腺切除术效果确切,损伤小,术后恢复快,住院时间短,是肾上腺手术的首选术式.

Laparoscopic adrenalectomy for adrenal tumors via transperitoneal or retroperitoneal approaches:A report of 56 cases

Objective To summarize the clinical experience of retroperitoneal and transperitoneal laparoscopic adrenalectomy for adrenal tumors.Methods Laparoscopic adrenalectomy was carried out in 56 cases of adrenal tumors via transperitoneal(10 cases) or retroperitoneal(46 cases) approaches.For transperitoneal laparoscopic adrenalectomy,the operation was performed through 3 abdominal trocars.After the peritoneum and the Gerota's fascia were opened,the adrenal gland or tumor were disconnected near the upper polar of the kidney.Then the tumor was removed by using the LigaSure system and a harmonic scalpel.For retroperitoneal laparoscopic adrenalectomy,a self-made balloon was used to dilate the retroperitoneal space.Then the Gerota's fascia was opened and the tumor was removed by using the LigaSure system and a harmonic scalpel. Results Of the 10 cases of transperitoneal adrenalectomy,conversions to open surgery were required in 3 cases because of extensive abdominal adhesion;of the 46 cases of retroperitoneal adrenalectomy,a conversion to open surgery was needed in 1 case because of massive hemorrhage of the inferior vena cava.Of the remaining 52 cases,the intraoperative blood loss was 20~200 ml(mean,70 ml) and no blood transfusion was needed.The operation time was 40~200 min(mean,110 min).The postoperative hospital stay was 3~8 d (mean,5.4 d).Follow-up for(6~36) months(mean,8 months) in 52 cases showed no tumor recurrence and metastasis.Conclusions Laparoscopic adrenalectomy has advantages of reliable effects,minimal invasion,rapid recovery,and short hospital stay.This procedure can be used as the first choice for the treatment of adrenal tumors.