后腹腔镜下肾上腺解剖学研究及临床应用

Anatomy Study and Clinical Application of Retroperitoneal Laparoscopic Adrenalectomy

目的:探讨后腹腔镜下肾上腺解剖学特点及其对手术入路合理设计的作用。方法:通过术前CT和(或)MRI、术中观察、反复观看手术录像及文献复习,对肾上腺的解剖学特点进行研究,将后腹腔镜下肾上腺手术总结为4个步骤,第1步清理腹膜外脂肪,第2步辨认解剖标志,第3步进入相应的解剖间隙并快速找到肾上腺,第4步依术前诊断和术中情况选择肾上腺或腺瘤切除术,并以此对33例肾上腺疾病患者施行了后腹腔镜下解剖性肾上腺切除术。结果:33例手术均取得成功,术中出血少,均未输血。术后住院4～8天,平均5.3天,无严重并发症发生。结论:明确手术步骤,术中正确辨认解剖标志和解剖间隙,可以提高后腹腔镜下肾上腺手术的成功率和安全性,缩短该手术的学习曲线。

Objective： To explore the anatomy and clinical application of retroperitoneal laparoscopic adrenalectomy. Methods：By preoperative CT and （or） MRI, intraoperative observation, repeatedly watched videos and review of surgery,the operation is divided into four steps through the anatomical studies of the adrenal glands. Step 1 clean extraperitoneal fat, step 2 identify anatomical marks, step 3 enter the corresponding anatomical clearance and quickly find adrenal, step 4 according to preoperative diagnosis and intraoperative conditions, selects adrenalectomy or adrenal adenoma excision, and thus 33 cases of adrenal disease underwent laparoscopic dissection of the adrenal gland. Results：33 operations are all successful with few blood loss,no serious complications observed,and the pre- operative diagnosis conformed by pathology. The average postoperative hospital stay was 5.3 days, ranged from 4 to 8 days. Conclusions： It is important to know the steps of operations well and to recognize the anatomic marks correctly. That will improve the success rate and security during retroperitoneal laparoscopic adrenalectomy.