大肾上腺肿瘤后腹腔镜切除的临床分析

Retroperitoneal Laparoscopic Adrenalectomy for selected adrenal tumors>6cm:our technique and experience

目的：探讨后腹腔镜切除大肾上腺肿瘤(最大直径大于6 c m)的可行性.方法：回顾性分析2002年6月~2013年6月上海长征医院泌尿外科98例行后腹腔镜下大肾上腺肿瘤切除患者的临床资料.98例均采用健侧卧位,用自制的气囊扩张后腹腔,分别在腋后线肋缘下、腋中线髂嵴上2 cm 及腋前线肋缘下穿刺,置入Trocar .用标本袋取出切除后肿瘤,留置引流管.结果：肿瘤最大直径6.5~12.6 c m,平均(8.1±3.2)c m,96例手术成功,早期2例中转开放,手术时间45~135 min ,平均65 min ,术中出血50~700 ml ,平均80 ml ,术后随访3~36个月,平均18.5个月,无局部复发及远处转移者87例,死亡9例,其中肿瘤相关死亡例数7例.结论：对于无明显禁忌证的患者,后腹腔镜手术切除大肾上腺肿瘤(＞8 c m)是可行的和安全的,肿瘤直径并不是手术的决定性因素.

Objective:To evaluate the feasibility of retroperitoneal laparoscopic adrenalectomy for large (>6 cm in diameter )adrenal tumors .Methods:A retrospective review was carried out on 98 patients with large adrenal tumors who underwent retroperitoneal laparoscopic adrenalectomy in our hospital between June 2002 to June 2013 . With the patients being placed in the lateral position at the uninjured side ,a self-made balloon was used to dilate the retroperitonealspace.Afterwards,3trocars wereinsertedviathecostal marginattheposterioraxillarylineandthe anterior axillary line ,and 2 cm above the anterior superior iliac spine at the middle axillary line to re move the tumors.Afterresectionofthetumor,andrainagetube wasindwelled.Results:The meandiameterofthetumors was (8.1 ±3.2 )cm (range ,6.5 to 12.6 cm).Retroperitoneal laparoscopic surgery was perfor med successfully on 96 ca-ses,and 2 cases were converted to opensurgery in the earlier period of our experience.The mean operation time was 65 min (range ,45 to 135 min),and the mean blood loss was 80 mL (range ,50 to 700 mL).Over a mean of l8.5-month follow-up (range ,3 to 36 months )was achieved in the cases ,during which 87 cases had no local recurrence . Nine cases died ,of which 7 were cancer related .Conclusions:When perfor med by experienced surgeons ,retroperito-neal laparosoopie adrenalectomyis feasible and safe for patients withlarge adrenal tumors (>8 cm)as long as no contraindication of the surgery is found .