后腹腔镜解剖性肾上腺肿瘤切除术38例临床分析

Retroperitoneal laparoscopic anatomical adrenalectomy for adrenal gland tumors(An analysis of 38 cases)

目的探讨后腹腔镜解剖性肾上腺肿瘤切除术的临床价值。方法对本科2005年3月至2009年6月开展的38例后腹腔镜解剖性肾上腺肿瘤切除术进行回顾性分析。38例中22例为皮质醇腺瘤,14例为醛固酮腺瘤,2例嗜铬细胞瘤。结果 38例手术均获成功。无大出血、感染及腹腔脏器损伤等并发症。平均手术时间90min(45～130min),估计平均失血量55ml(25～90ml),无需输血。术后1～2d拔除引流管和尿管,平均住院5.6d(4～8d)。术后随访6～24个月,平均12个月,3例患者失访,其余患者术后临床症状和体征均恢复正常,未见肿瘤复发。结论后腹腔镜解剖性肾上腺肿瘤切除术具有术野清晰、出血少、手术时间短和并发症少等优点,有望成为肾上腺良性疾病首选手术方法。

Objective To evaluate retroperitoneal laparoscopic anatomical adrenalectomy for benign adrenal tumors.Methods From March 2005 to June 2009,38 cases with benign adrenal tumors underwent retroperitoneal laparoscopic anatomical adrenalectomy in our hospital.The clinical data were record and analyzed.Among 38 cases,there were 22 cases with cortisol asenoma,14 cases with aldosterone-producing adenoma and 2 case with adrenal pheochromocytoma.Results The operations were successful in all 38 cases without massive hemorrhage,infection or abdominal visceral injury.The mean operation time was 90 min（range from 45 to 130 min）.The estimated mean blood loss was 55 ml（range from 25 to 90 ml） without transfusion.Drainage and catheter were removed 1～2d postoperatively.The postoperative hospital stay was 5.6 d（3～14 d）.The follow up time ranged from 6 to 24 months,with an average of 12 months.Loss follow-up was in 3 cases.The clinical manifestation of 35 cases were normal and no tumor recurrence was found.Conclusion Retroperitoneal laparoscopic anatomical adrenalectomy has many advantages,including clear operative field,less blood loss,shorter operative time and less complications.It should be considered as the first choice of operative method for benign adrenal diseases.