后腹腔镜在肾上腺手术中的应用(附72例报告)

Clinical applications of retroperitoneal laparoscopic adrenalectomy(report of 72 cases)

目的探讨腹腔镜下肾上腺肿瘤切除的方法和应用体会。方法采用腹膜后腹腔镜对72例患者行肾上腺占位性病变切除术。左侧30例,右侧42例。结果完成腹膜后腹腔镜手术69例,因术中出血、脂肪过多和粘连而解剖位置不清中转开放手术各1例。手术时间40～200min,平均110min。术中出血20～200ml,平均70ml。住院时间3～7d,平均5.2d。所有患者均未输血,无严重并发症。对完成手术的69例患者随访6～54个月,平均26个月,其中2例皮质癌患者原位复发。结论腹膜后腹腔镜肾上腺占位性病变切除术具微创、安全有效、患者术后康复快和住院时间短等优势,是治疗肾上腺占位性病变的首选方法。

Objective To summarize the procedure and clinical experience of retroperitoneal laparoscopic adrenalectomy. Methods Seventy-two cases（30 cases left,42 cases right）of adrenalectomy had been performed by laparoscope retroperitoneally. Results Of the 72 cases,3 cases were converted to open surgery because of bleeding, extensive adhesion and obesity. The mean operating time was 110min（40-200 min）,average blood loss was 70ml（20-200ml）and postoperative hospitalization was 3-7 d（mean 5. 2 d）. No blood transfusion was needed in all cases. No operative complication occurred. Follow-up was for 6-54 months（mean 26 months）in 69 cases,which showed that 2 cases diagnosised with primary adrenal cortical adenocarcinoma recurred. Conclusions Retroperitoneal laparoscopic adrenalectomy is a safe, effective procedure and contains all the advantages of minimally invasive surgery：less traumatic,less blood loss and quicker recovery. It should be considered as the first choice of therapy for most adrenal disorders.