经脐单孔腹腔镜肾上腺部分切除术治疗肾上腺腺瘤(附6例报告)

Partial Adrenalectomy by Laparoendoscopic Single-site Transumbilical Surgery for Adrenal Adenoma(Report of 6 Cases)

目的:总结经脐单孔腹腔镜下行肾上腺部分切除术治疗肾上腺腺瘤的临床经验并探讨其可行性。方法:2009年10月～2011年1月采用自制的多通道单孔设备对6例肾上腺腺瘤患者行经脐单孔腹腔镜下肾上腺部分切除术,腺瘤直径(2.3±0.5)cm。脐部作1～2 cm弧形切口,置入自制多通道单孔设备、普通腹腔镜及可弯器械,切开后腹膜,于肾上极内侧游离肾上腺肿瘤,完整切除腺瘤,尽可能保留正常肾上腺。结果:6例手术均顺利完成,手术时间(123.3±23.4)min,,出血量平均(86.5±12.4)ml。术后有1例患者血压较高,采用降压药物后控制,其余均无高血压及肾上腺危象表现,血钾均恢复至正常水平。住院时间平均3天。术后病理检查证实为肾上腺腺瘤。6例随访3～12个月,脐部切口愈合良好,无脐疝等并发症。复查B超及腹部CT均无复发。结论:采用自制的多通道设备行经脐单孔腹腔镜下肾上腺部分切除安全、可行,瘢痕隐蔽,美容效果好,是临床治疗肾上腺腺瘤的一个新选择。

Objective.. To summarize the experience of single-site transumbilical surgery of partial adrenalectomy and explore its feasiblility. Methods：6 patients of adrenal adenoma underwent partial adrenalectomy by laparo- endoscopic single-site transumhi[ieal surgery with home-made multi-channel single-port equipment from Oct. 2009 to Jan. 2011. 4 males,2 females. 3 in left and 3 in right.. The mean age was 50.7 （39-59） years,the mean size of adrenal masses was （2.3±0.5）（0.5-3.2） cm. 4 cases with refractory hypertension, 3. Results.. 6 cases were completed successfully. The mean operative time （123.3 ± 23.4）（90-160）min, ,the mean blood loss （86.5± 12.4）ml, Pathologically confirmed adrenal adenoma. 6 patients were followed up for 3-12 months, the umbilical incision healed well and no umbilical hernia and other complications, review the B-and abdominal CT, no recurrence. Conclu- sions..The Laparoendoscopic single-site transumbilical surgery of partial adrenalectomy is safe and feasible, scar hidden,good cosmetic results and could be a new clinical treatment of adrenal adenoma.