肾上腺病变的后腹腔镜手术切除

Retroperitoneal laparoscopic adrenalectomy (Report of 65 cases)

目的 :探讨后腹腔镜手术切除肾上腺病变的效果。方法 :对 6 5例肾上腺病变患者行后腹腔镜肾上腺病变切除术。结果 :6 5例手术时间为 4 5～ 2 19min ,平均为 74min。术中出血 2 0～ 30 0ml,平均 5 0ml。患者术后第 2天下床活动并进流质饮食 ;引流管于术后 2～ 3天拔除 ;穿刺孔周围皮下气肿 2～ 3天后自动吸收 ;平均住院时间 6d。问卷调查 ,患者均于术后 7～ 2 0天 (平均 12天 )恢复正常生活。结论 :后腹腔镜下手术切除肾上腺病变是一种微创、安全、有效、患者住院时间短、术后恢复快的术式。

Objective:To explore the efficacy of retroperitoneal laparoscopic adrenalectomy. Methods:65 adenalectomies were performed by retroperitoneal laparoscopy.Results:Of 65 laparoscopic surgery, 1 conversion to open surgery was necessary in 1 patient with pheochromocytoma due to uncontrolled bleeding caused by adenoma envelope teared, 1 open surgery should be done as a result of hemorrhage from adrenal gland remnants on the 1st day after laparoscopic adenalectomy, other 63 retroperitoneal laparoscopic adenalectomies were underwent successfully. Operative time ranged from 45～219 min (mean 74 min). Estimated intraoperative blood loss were about 20～300ml (mean 50ml). Adrenal gland partial rupture occurred in 12 patients, peritoneal perforation in 8, subcutaneous emphysema around the ports in 22 and absorbed spontaneously 3 days after the treatment. All patients resumed activities and begun oral intake 2 days after operation and the drain tubes was removed 2 to 3 days. The average hospital stay was 6 days. Questionnaire survey showed the patients resumed normal work in 7 to 20 days (mean 12 days) postoperatively.Conclusions:Our initial experience showed that retroperitoneal laparoscopic adrenalectomy was minimally invasive and safe surgical technique with short length of hospital stay and rapid recovery.