半侧卧位后腹腔镜下肾上腺手术体会

Retroperitoneoscopic adrenalectomy in semilateral supine position

目的介绍半侧卧位后腹腔镜下肾上腺手术方法及经验。方法2006年1月至2008年12月，采用自行设计的60°～70°半侧卧位行后腹腔镜下肾上腺手术36例。男20例，女16例。年龄23～67岁，平均43岁。肾上腺皮质腺瘤18例，嗜铬细胞瘤6例，囊肿3例，髓质脂肪瘤2例，神经节细胞瘤1例，淋巴管瘤1例，转移瘤1例，肾上腺皮质增生4例。肿物直径0．5～7．7cm，平均2．6em。肾上腺肿物位于。肾上极上方5例（左2例，右3例），肾上极前内侧10例（左8例，右2例），内上方17例（左8例，右9例）。相对于侧位术式，术中穿刺孔位置前移，分离平面主要位于肾前面及内上方，可避开肾脏对操作的影响，病灶显露满意。结果36例手术顺利完成。手术时间37～145min，平均69min。术中出血量30～100ml，平均48ml。术中发生腹膜破裂6例，闭合后继续完成手术。术后住院时间3～8d，平均5d。35例获随访3～28个月，平均14个月，1例转移性肿瘤患者术后第12个月死于原发病，未发生其他并发症。结论半侧卧位后腹腔镜下肾上腺手术能有效减少肾脏的阻挡，有利于肾上腺区的暴露，可提高手术安全性。

Objective To discuss the semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008, 36 patients （20 males and 16 females with mean age of 43 years） underwent retroperitoneoscopic adrenalectomy in 60° -70°semilateral supine position. There were adrenal cortex adenomas in 18 cases, pheochromocytoma in 6 cases, adrenal cysts in 3 cases, myelolipoma in 2 cases, gangliocytoma in 1 case, lymphangioma in 1 case, metastatic tumor in 1 case and eorticohyper- plasia in 4 cases. The mean diameter of the tumors was 2.6 cm （ 0.5 - 7.7 cm ）. The tumors were superior to the renal pole in 5 eases, anteromedial in 10 cases and superomedial in 17 cases. The three ports that were usually used in lateral position and were placed anteriorly to create retroperitoneal place： the first port was placed 2 -4 cm superior to the iliac crest along the anterior axillary line, the other two were placed just below the costal margin along the midaxillary line and at the same level along the midclavicular line, and dissected along the anterior surface of kidney to its superomedial aspect, so as to avoid the hampering of the kidney in the exposing of the diseased adrenal gland. in all of the cases with the operating time of 37 - 145 Results The procedure was completed successfully min （mean 69 rain） and intraoperative blood loss of 30 - 100 ml （ mean 48 ml）. Six cases had rupture of peritoneum, which were sutured and the procedure was continued to completion. The postoperative hospital stay was 3 - 8 d （mean 5 d ）. Thirty-five patients were available for follow-up of 3 - 28 months （ mean 14 months）. The case of metastatic tumor died of the primary diseases in the 12th month postoperatively. No other complication was found. Conclusion With this al- ternative position and ports＇ location, the procedure of retroperitoneoseopic adrenaleetomy could be easier and safer than the conventional position.