巨大肾上腺肿瘤的腹腔镜手术(附29例报告)

Laparoscopic operation for large adrenal tumors:with a report of 29 cases

目的:探讨分析巨大(直径≥6cm)肾上腺肿瘤行腹腔镜手术的有效性和安全性。方法:回顾分析为29例巨大肾上腺肿瘤患者行腹腔镜手术的临床资料。结果:29例均顺利施行腹腔镜肾上腺肿瘤切除术,经腹腔途径17例,经腹膜后途径12例。肿瘤直径6.0～9.5cm,平均(6.7±2.5)cm,手术时间85～180min,平均(98±35)min,术中出血90～1200ml,平均(225±87)ml,术后胃肠功能恢复时间24～70h,平均(38±25)h,术后2～3d拔除引流管,术后住院6～10d,平均(5.7±2.3)d。随访12～36个月,平均20.5个月,27例患者临床症状消失,2例皮质腺癌复发。结论:螺旋CT及三维重建可为巨大肾上腺肿瘤患者的进一步治疗提供指导。随着技术的不断进步,巨大肾上腺肿瘤不再是腹腔镜手术的绝对禁忌证,腹腔镜手术安全、有效,已成为巨大肾上腺肿瘤患者可选择的有效术式。

Objective：To investigate and analyze the clinical safety and efficacy of laparoscopic operation for large adrenal tumors （diameter≥6cm）. Methods：Twenty-nine laparoscopic operations were performed for patients with larger adrenal tumors. The perioperative clinical data were analyzed retrospectively. Results ：Twenty-nine adrenal tumorectomy were performed successfully, 17 cases by intra-abdominal approach and 12 cases by retroperitoneal approach. The diameter of tumor was 6.0-9.5cm, mean （6.7 ± 2.5 ） cm. The operation time was 85-180rain, mean （98 ± 35 ） min. The blood loss was 90-1 200ml, mean （ 225 ± 87 ） ml. The patients could take food normally after 24-70h, mean （ 38 ± 25 ） h. The drainage tube was pulled out after 2 to 3 days. The patients stayed in hospital 6- 10d,mean （5.7 ± 2.3 ）days after operation. Follow-up time ranged from 12 to 36 months（ mean 20.5 months）. The clinical symptoms of 27 patients disappeared,2 cases of cortical carcinoma recurred. Conclusions：Spiral and three-dimensional CT is conducive to the differential diagnosis and treatment of large adrenal tumors. With the development of technology,large adrenal tumor is no longer an absolute contraindication for laparoscopic operation. Laparoscopic surgery is safe and effective, and has become an option of effectively surgical method for large adrenal tumors.