后腹腔镜肾上腺手术89例报告

Retroperitoneal laparoscopic adrenalectomy(report of 89 cases)

目的总结后腹腔镜肾上腺手术的方法及临床应用价值。方法回顾性分析2002年1月—2009年10月我院行腹腔镜手术治疗肾上腺疾病89例患者的临床资料。术前经超声、CT或MRI等诊断为肾上腺病变。病变位于左侧46例,右侧41例,双侧2例;瘤体直径1.0～6.5 cm,平均3.2 cm。结果 87例手术成功,2例中转开放手术。手术时间40～275 min,平均(136.2±62.3)min。术中出血20～200 ml,平均(91.0±48.2)ml。无输血和严重并发症发生。术后住院时间5～7d,平均(6.2±0.8)d。术后病理报告均为良性肿瘤,嗜铬细胞瘤21例,肾上腺皮质增生7例,肾上腺皮质腺瘤42例。节细胞神经瘤3例,髓性脂肪瘤7例,肾上腺囊肿6例,肾上腺结核1例,胃后壁憩室1例,脾脏种植1例。发生腹膜破裂4例,瘤体破裂出血1例,穿刺口脂肪液化3例。随诊3～24个月,所有患者影像学检查未见肿瘤复发或转移。功能性肿瘤患者症状减轻或消失。结论后腹腔镜肾上腺手术具有创伤小,术中出血少,术后恢复快等优点,但需根据肿瘤大小和病理类型严格掌握,重视局部解剖关系。

Objective To summarize clinical experience and effects of laparoscopic adrenalectomy.Methods The clinical data of 89 cases with laparoscopic adrenalectomy from January 2002 to October 2009 ere analyzed retrospectively.Via the retroperitoneal approach,89 cases diagnosed adrenal tumors by ultra-sound,CT or MRI and underwent laparoscopic adrenalectomy in our hospital.The tumors were on the left side in 46 cases,on the right side in 51 cases,and on both sides in the other side.The tumor diameters ranged from 1.0 to 6.5 cm with mean of 3.2 cm.Results The operations were successfully accomplished in 87 cases,2 cases were converted to open operation.The operation time was 40-275 min,mean（136.2±62.3） min.The blood loss was 20-200ml,mean（91.0±48.2）ml.There were no blood transfusion and severe complications in the study.The hospital stay was 5-7 d,mean（6.2±0.8）d.The result of pathologic diagnosis： pheochromocytoma in 21 cases,7 cases of adrenal hyperplasia,adrenal cortical adenoma in 42 cases.Ganglioneuroma in 3 cases,7 cases of myelolipoma,adrenal cyst in 6 cases,1 case of adrenal tuberculosis,1 case of gastric diverticulum wall,spleen grown in 1 case.4 cases of peritoneal rupture,aneurysm rupture occurred in 1 case,3 cases of fat liquefaction puncture.The follow-up time was 3 to 22 months,imaging studies found no recurrence or metastasis in all patients.Functional symptoms of cancer patients were reduced or disappeared.Conclusion Laparoscopic adrenalectomy was advantages of less trauma 、 less bleeding 、faster postoperative recovery,and so on,but indication should base on tumor size and pathological type strictly,while local anatomical relationship must be paid more attention.