腹腔镜肾上腺手术中转开放手术及合并症分析

目的　分析腹腔镜肾上腺手术中转开放手术原因及合并症处理。　方法　对 19例腹腔镜肾上腺肿瘤切除术中 8例转开放手术的原因及合并症进行分析。　结果　 8例手术中转开放手术患者包括右肾上腺中静脉出血 1例 ,胰尾遮挡肾上腺肿瘤暴露困难 1例 ,左肾上腺囊肿被副脾遮挡1例 ,手术过程中气腹不满意 2例 ,未找到病灶 2例 ,腹膜后镜手术穿刺时引起腰大肌出血 1例。术后高热 3例 ,其中腹膜后脓肿 1例 ,反应性胸膜炎 1例。　结论　腹腔镜和腹膜后镜手术需要一定经验和熟练的配合 ,初学者操作易出现合并症 ,导致手术失败。腹膜后镜手术治疗肾上腺疾病更简便

An analysis of the cause of laparoscopic adrenalectomy failure and its complications

Objective To study and to analyse the cause of laparoscopic adrenalectomy failure and its complications. Methods 8 of 19 laparoscopic adrenalectomies were converted to open surgery .The cause of failure and its complications were analysed. Results The causes to convert to open surgery were:bleeding of right middle suprarenal vein in 1,adrenal tumor was sheltered of cauda pancreatis in 1,left adrenal cyst was sheltered by spleen in 1,CO 2 pneumoperitoneal pressure can not be maintained during the procedure in 2,tumers could not be found in 2,the telescopic port was inserted into musculus psoas major in the retroperitoneal approach and the bleeding influenced the operation field in 1.3 patients had high fever after operations and 1 had an abscess in the adrenal bed.Reactive pleuritis occurred in 1. Conclusions Fine technique and experiences were needed for laparoscopic procedures and good team work between the operators was very important.Complications were often associated with the initial cause that led to the laparacospic adrenalectomy failure.Laparoscopic adrenalectomy via the retroperitoneal approach has been easier than that via the transperitoneal approach.