单切口经腹膜内途径腹腔镜下切除肾上腺肿瘤的初步尝试

Single incision for trans-peritoneal laparoscopic adrenalectomy in treatment of adrenal tumors

目的:初步尝试采用单切口经腹膜内腹腔镜技术行肾上腺肿瘤切除,探讨其临床疗效及安全性,为进一步临床应用奠定基础。方法:采用经腹腔内途径单切口腹腔镜技术对3例肾上腺肿瘤患者行肿瘤切除术,术中选择腋前线肋缘下3cm切口,切口内置入3枚Trocar套管针,手术过程中使用Cambridge Endo头端可弯腹腔镜器械、超声刀技术、Hem-o-lok等对3例肾上腺肿瘤进行切除。结果:3例手术均取得成功,无中转开放或术中增加Trocar套管针辅助。手术时间分别为75、116、135min,平均(108.7±30.7)min,术中出血10、20、30ml,平均(20±10)ml,术后1d拔除胃管、导尿管,术后3d拔除腹腔引流管,术后住院时间均为4d。结论:单切口经腹膜内途径腹腔镜下肾上腺肿瘤切除术具有创伤小、出血少、安全性高、术后住院时间短的优点,但手术操作难度较大。

Objective：To perform trans peritoneal laparoscopic adrenalectomy via a single incision in treatment of adrenal tumors, and to discuss its clinical outcome and safety. Methods：Single incision trans-peritoneal laparoseopic adrenaleetomy was used in treatment of three patients with adrenal tumors. The incision was made 3 cm below the costal margin of anterior axillary line; three Tocars were placed in the cut. The instruments used included single port access, CUSA, Hem-o-lok, etc.. Results： The three operations were all successful, and there were no conversion to open procedure or a need for extra Ttrocars. The operating time periods were 75,116, and 135 min,whh a mean of （108.7±30.7）rain. The perioperative blood losses were 10,20,and 30 ml,with a mean of （20±10）ml. The gastric canal and ureteral catheter were withdrew one day after operation, and the drainage tube was withdrew 3 d after operation. The mean postoperative hospital stay was 4 d. Conclusion： Single incision trans peritoneal laparoscopic adrenalectomy has the advantage of little trauma,less blood loss,satisfactory safety,and prompt postoperative recovery,but is difficult to manage.