后腹腔镜治疗肾上腺肿瘤35例临床分析

Retroperitoneoscopic treatment for adrenal tumors: A clinical analysis of 35 cases

目的总结后腹腔镜技术治疗肾上腺肿瘤的临床经验.方法采用后腹腔镜切除肾上腺肿瘤35例,男12例,女23例.年龄25岁～72岁,平均49.8岁.左侧15例,右侧20例.其中嗜铬细胞瘤5例,原发性醛固酮增多症10,柯兴氏病2例,神经节细胞瘤2例,无功能性腺瘤16例.腰部取3个套管针穿刺入路,用自制的水囊扩张器扩张后腹腔,用超声刀将肿瘤切除.结果 35例手术均成功,无中转开放手术病例.术中出血量10～500 ml,平均74 ml.病人均未输血.手术时间45～200 min,平均90 min.结论后腹腔镜手术切除肾上腺肿瘤手术效果确切,手术时间短,术中出血少,损伤小,术后恢复快,可以替代绝大多数肾上腺肿瘤开放手术.

Objective To summarize the clinical experience of retroperitoneoscopic surgery in the treatment ot adrenal tumors. Methods Retroperitoneoscopic resection of adrenal tumors was performed in 35 patients （ 12 males and 23 females） aged 25 -72 years （mean, 49.8 years）. The tumor was left - sided in 15 patient and right - sided in 20 patients. There were 5 cases of pheochromocytoma, 10 cases of primary hyperaldosteronism, 2 cases of Cushing＇ s disease, 2 cases of paraganglioma, and 16 cases of dysfunctional adcnoma. The operation was performed through 3 lumbar ports. A self - made water - filled balloon dilator was employed to expand the retroperitoneal cavity, and then the tumor was removed by using a harmonic scalpel. Results The procedure was successfully completed in all the 35 patients, with no need of conversions to open surgery. The intraoperative blood loss was 10 -500 ml （mean, 74 ml）. No blood transfusion was required. The operation time was 45 -200 min （mean, 90 min）. Conclusions Retroperitoncoscopic adrenalectomy has advantages of satisfactory effects, short operation time, little blood loss and invasion, and quick recovery. It can replace most of traditional open operations for adrenal tumors.