经腹腔入路腹腔镜肾上腺切除术治疗肾上腺肿瘤371例报告

Transperitoneal laparoscopic adrenalectomy for adrenal neoplasm: a report of 371 cases

背景与目的:目前,腹腔镜肾上腺切除术已基本取代了开放性肾上腺切除术,腹腔镜下肾上腺切除手术途径主要有经腹腔和经腹膜后两种。本文总结经腹腔入路腹腔镜肾上腺切除手术经验。方法:对2003年2月至2008年8月在我院行腹腔入路的腹腔镜肾上腺切除病例的临床资料进行回顾性分析,共有371例,其中原发性醛固酮腺瘤127例,柯兴氏腺瘤117例,嗜铬细胞瘤58例,无功能腺瘤37例,其它病变32例。对肾上腺病变类型、腹腔镜手术的时间、出血量、并发症和预后进行总结,并对手术方法进行分析。结果:365例(98.4%)手术成功,5例(1.4%)中转开放手术,1例因肿瘤广泛侵犯放弃手术。手术时间40～240min,平均70min;术中出血量20～1000mL,平均80mL。膈肌损伤2例,结肠和肾静脉损伤各1例。术后平均住院时间5d。结论:腹腔入路腹腔镜肾上腺手术是治疗肾上腺肿瘤的理想方法之一。

Background and Objective： Open adrenalectomy has been almost replaced by mini-invasive laparoscopic surgery. There are two popular miniinvasive laparoscopic adrenalectomy approaches： retroperitoneal and transperitoneal approaches. This study was to summarize our experience in transperitoneal laparoscopic adrenalectomy. Methods：In total 371 cases undergoing transperitoneal adrenalectomy in the First Affiliated Hospital of Zhengzhou University from February 2003 to August 2008 were reviewed retrospectively. There were 127 cases of primary hyperaldosteronism adenoma, 117 cases of Cushing＇s adenoma, 58 cases of phaeochromocytoma, 37 cases of incidentoma and 32 cases of other types. The type of adrenal diseases, operating time, blood loss, complications and prognosis were summarized and the operating method was analyzed. Results. Three hundred and sixty-five out of 371 patients （98.4%） were successfully operated, five cases （1.4%） were transferred to open surgery, and one patient gave up surgery due to extensive invasion. The operating time was 40- 240 min （average, 70 min）. The blood loss was 20-1000 ml （average, 80 ml）. Two patients suffered from diaphragm injuries, one patient had right renal vein injury and one had colon injury. The mean time of hospital stay was five days. Conclusion： TranSperitoneal laparoscopic adrenalectomy is one of the favorable approaches for the treatment of adrenal neoplasm.