肾上腺占位性疾病后腹腔镜手术暴露与术式探讨(附84例报道)

Research on surgical exposition and surgical pattern in retroperitoneal laparoscopy for adrenal mass(report of 84 cases)

目的探讨肾上腺占位性疾病后腹腔镜手术时,后腹腔空间制备、暴露肾上腺的方法及手术方式的选择。方法回顾性分析2004年9月至2009年9月经后腹腔镜手术治疗肾上腺占位性疾病84例患者的临床资料。结果 84例中行肾上腺切除术31例,行肾上腺部分切除术或肿瘤摘除术53例。平均手术时间115 min,平均建立后腹腔间隙时间6 min,术中平均出血量40 mL,84例手术全部成功,无严重并发症发生。结论观察镜直接分离加水囊扩张法制备后腹腔空间快速有效,沿上半肾周脂肪囊与Gerota筋膜间游离可快速安全暴露肾上腺,良性病变尽量保留部分肾上腺,恶性肿瘤和嗜铬细胞瘤选择肾上腺切除。中央静脉应慎重处理。

Objective To research the method for fairly establishing retroperitoneal space and exposing adrenal gland along with choice of surgical patterns in retroperitoneal laparoscopy for adrenal mass. Methods Retrospectively analyze the clinical data of 84 cases of adrenal mass treated with Retroperitoneal laparoscopy at our hospital during September, 2004 to September, 2009. Results Adrenalectomy for 31 cases,partial adrenalectomy or excision of adrenal tumor for 53 cases, the average surgical time was 115 mi- nutes,the average time for establishing retroperitoneal space is 6 minutes,the average volume of blood loss is 40 mL,the surgeries for all 84 cases were successful without severe complication. Conclusion Retroperitoneal space can be quickly and efficiently estab- lished through direct dissociation by applying observation scope combinated with expansion by applying handmade waterbag, the ad- renal gland can be quickly and safely exposed by dissociating between upper perinephric fatty capsule and Gerota fascia. Partial ad- renal gland should be reserved in adrenal benign mass if possible, adrenalectomy should be applied in adrenal malignant mass or ad- renal oheochromcvtoma. The central vein has to be carefully handled.