后腹腔镜单切口肾上腺切除术的临床观察

Laparoendoscopic single-site retroperitoneal adrenalectomy： a report of 7 cases

目的探讨后腹腔镜下单切口技术行肾上腺肿瘤切除手术的可行性和应用价值。方法2009年10月至2011年1月采用后腹腔镜单切口技术对7例肾上腺肿瘤的患者实施肾上腺切除术，采用腰部腋中线切口，长约2～3cm，置入自制的单切口Port，手术过程分别使用Cambridge endo可弯单通道腹腔镜器械、普通腹腔镜器械等，回顾性分析患者术中、术后情况。结果6例单切口肾七腺切除手术取得成功，未增加皮肤切口，亦未中转开放或传统腹腔镜手术；1例因肿瘤较大（直径6cm）、术中暴露困难，改传统腹腔镜手术。平均手术时间139min（95～200min），平均术中出血96ml（30～350ml），术后住院平均时间为5d（3～8d），围手术期无并发症发生。结论对于肿瘤直径较小的肾上腺肿瘤，经后腹腔镜单切口肾上腺切除术是安全、可行的。

Objective To summarize our preliminary clinical experiences of laparoendoscopic single-site （LESS） retroperitoneal adrenalectomy. Methods Since October 2009 to January 2011, the investigators have performed LESS retroperitoneal adrenaleetomy for 7 patients with adrenal tumors. A waist axillary midline incision of around ：2 - 3 cm was made and a single incision for inserting a homemade port. Cambridge endo flexible laparoscopic instrument and other common laparoscopic accessories were used during the surgical procedures. Results LESS retroperitoneal adrenalectomies were technically successful in 6 cases with no extra skin incisions, no conversion into an open procedure or standard laparoscopy. Conversion to standard laparoscopy （3 ports） was inevitable in one case. The reason for conversion was due to tumor size （6 cm）. No perioperative complication occurred. The mean operative duration was 139 min （95 -200 min）, the mean volume of blood loss 96 ml（30 -350 ml） and the mean hospital stay 5 d（3 - 8 d）. Conclusion LESS retroperitoneal adrenalectomy is technically feasible and safe for the treatment of small adrenal tumors.