后腹腔镜手术切除巨大肾上腺肿瘤

Retroperitoneal Laparoscopic Adrenalectomy for Large Adrenal Tumors

目的探讨后腹腔镜手术切除巨大(≥6cm)肾上腺肿瘤的可行性。方法2002年6月～2008年6月对30例直径≥6cm巨大肾上腺肿瘤行后腹腔镜切除手术。采用健侧卧位,用自制的气囊扩张后腹腔,分别在腋后线肋缘下、腋中线髂嵴上2cm及腋前线肋缘下穿刺,置入trocar。肿瘤切除后用标本袋取出肿瘤,留置引流管。结果30例后腹腔镜手术成功,无中转开放手术。平均手术时间100min(65～185min),术中出血量平均80ml(50～250ml)。30例术后随访3～36个月,平均18.5月,无局部复发。结论对于无明显禁忌证的肿瘤,后腹腔镜手术切除巨大肾上腺肿瘤可行、安全,肿瘤直径并不是手术的决定性因素。

Objective To evaluate the feasibility of retroperitoneal laparoscopic adrenalectomy for large （≥ 6 cm in diameter） adrenal tumors. Methods Between June 2002 and June 2008, 30 patients with large adrenal tumors underwent retroperitoneal laparoscopic adrenalectomy in our hospital. With the patients being placed in the lateral position at the uninjured side, a self-made balloon was used to dilate the retroperitoneal space. Afterwards, 3 trocars were inserted via the costal margin at the posterior axillary line and the anterior axillary line, and 2 cm above the anterior superior iliac spine at the middle axillary line to remove the tumors. After resection of the tumor, an drainage tube was indwelled. Results Retroperitoneal laparoscopic surgery was performed successfully in the 30 cases without conversion to open surgery. The mean operation time was 100 min （range, 65 to 185 rain）, and the mean blood loss was 80 ml （range, 50 to 250 ml）. Over a mean of 18.5-month follow-up （ range, 3 to 36 months） was achieved in the cases, during which no one had local recurrence. Conclusions Retroperitoneal laparoscopic adrenalectomy is feasible and safe for patients with large adrenal tumors as long as no contraindication of the surgery is found. The diameter of the tumor does not play a role when determining the surgery.