后腹腔镜手术切除肾上腺肿瘤(附80例报告)

Retroperitoneal laparoscopic adrenalectomy for the treatment of adrenal tumors(Report of 80 cases)

目的：探讨应用后腹腔镜术切除肾上腺肿瘤的疗效和安全性。方法：应用后腹腔镜手术切除肾上腺肿瘤80例：功能性肾上腺肿瘤56例，非功能性肾上腺肿瘤24例。用自制的气囊扩张后腹腔，腰部3个Trocar穿刺入路，超声刀将肿瘤切除，用自制的标本袋取出肿瘤。结果：80例中73例完全由腹腔镜手术完成，7例因术中粘连、出血等改开放手术。术中出血量10～500ml，平均70ml。患者均未输血。76例随访3～48个月，平均8个月，未见肿瘤复发和转移，血电解质、儿茶酚胺、醛固酮、皮质醇等肾上腺内分泌检查均恢复正常；但12例仍有高血压。结论：应用后腹腔镜术切除肾上腺肿瘤安全、创伤小、恢复快，对肾上腺恶性肿瘤主张行开放手术。

Objective：To evaluate the safety and feasibility of retroperitoneal laparoscopic adrenalectomy for the treatment of adrenal tumors. Methods： From January 2003 to July 2007.80 cases of adrenal tumors were treated with retroperitoneal laparoscopy in our hospital. There were functional gland tumors in 56 cases,including 21 cases of Cushing＇s syndrome, 15 cases of aldostcrone producing adenoma and 17 cases of adrenal pheochromocytoma and 3 cases of paraganglioma. There were, adrenal non-functional tumors in 24 cases. A self-made balloon was used to dilate the retroperitoneal space and the operation was performed through 3 trocars. The tumor was removed by a harmonic scalpel. Results： Among the 80 cases of retroperitoneal laparoscopic adrenalectomy, 73 cases was successfully completed and 7 cases was transfered to open surgery because of intraoperative bleeding or extensive adhesion. The operation time was 30- 170 minutes with a mean of 73 minutes. No blood transfusion needed, with the blood loss ranging from 10 to 500 ml. Follow up time ranged 3-48 mouths（ mean, 8 mouths）. No tumor recurrence and metastasis was noted in 76 cases. Conclusions： Retroperitoneal laparoscopic adrenalectomy is a procedure with less invasive, less bleeding, rapid postoperative recovery,and fewer complication. Laparoscopic adrenalectomy should be considered as the first choice in treating adrenal benign tumors.