经脐单孔腹腔镜下肾上腺全切除术的初步探讨

The initial experience of laparoscopic single-site transumbilical adrenalectomy

目的探讨经脐单孔腹腔镜下肾上腺全切除术的可行性及安全性。方法采用经脐单孔三通道入路,对6例肾上腺腺瘤、4例肾上腺增生患者行经脐单孔腹腔镜下肾上腺全切除术。其中男性3例,女性7例,平均年龄43.5岁,平均体重指数24.56。所有患者于肚脐处作一2～3cm切口,置入1个5mm和2个10mm穿刺器,穿刺器之间采用医用橡胶手套固定防止漏气。手术操作通过可弯钳及电凝钩并配合超声刀完成。肾上腺中央静脉用Hem-o-lok结扎并切断,标本放入标本袋后经切口取出。结果10例手术均取得成功,除2例右侧肾上腺患者于肋缘下另加了一个3mm穿刺器外,其余患者均未中转开放、未改传统腹腔镜手术及另加穿刺器。手术时间65～145min,平均85min;出血量20～110ml,平均56ml;术后当天即可下床活动,肚脐仅留一2～3cm大小的手术疤痕。结论经脐单孔腹腔镜下肾上腺全切除术安全可行,切口美观,具有较好的微创效果,远期的临床效果需要进一步观察。

Objective To evaluate the feasibility and reliability of laparoendoscopic single-site transumbilical adrenalectomy. Methods 10 cases （6 with adenoma, 4 with adrenal hyperplasia） underwent laparoendoscopic single-site transumbilical adrenalectomy. The mean age was 43.5 years. The mean body mass index was 23.56. In all cases, a 2-3cm single longitudinal supraumbilical incision was made. Two 10-ram and one 5-ram trocars were inserted, and medical rubber glove was sutured surrounding the three trocars and incision for gas proofing. Flexible electric coagulation hook and straight ultrasound knife were used for dissection. Adrenal main vein was ligated using hemoclips. The adrenal gland was extracted via a specimen bag by incision. Results All the operations were successfully completed without conversion to open or traditional laparoseopic surgery, though a 3mm trocar was used for pushing the liver in two cases. The mean operating time was 85（65-145） minutes. The mean estimated blood loss was 56 （20-110） ml. All patients recovered out-of-bed activity after anesthesia with only one 2-3 cm not detectable scar on the navel. Conclusions laparoendoscopic single-site transumbilical adrenaleetomy represents a feasible and novel mini-invasive option for patients with adrenal hyperplasia or adenoma. However, the long-term effects of the procedure need to be further investigated.