经腹腔入路腹腔镜下肾上腺切除术治疗大肾上腺肿瘤71例报告

Transperitoneal laparoscopic adrenalectomy for large adrenal neoplasm:a report of 71 cases

目的目前腹腔镜下肾上腺切除术已基本取代了开放性肾上腺切除术。本文讨论经腹腔入路腹腔镜下大肾上腺肿瘤(直径大于5.5 cm)切除手术的安全性及可靠性。方法对2003年2月至2010年12月在郑州大学第一附属医院行腹腔入路的腹腔镜肾上腺切除病例的临床资料进行回顾性分析,共有71例,其中原发性醛固酮腺瘤25例,柯兴氏腺瘤17例,嗜铬细胞瘤11例,无功能腺瘤8例,其它病变10例。对肾上腺病变类型、腹腔镜手术的时间、出血量、并发症和预后进行总结阐述腹腔镜手术对大肾上腺肿瘤治疗的安全性及可靠性。结果 71例大肾上腺肿瘤患者手术均获得成功,70例(98.6%)经腹腔镜手术获得成功,1例(1.4%)术中转为开放手术获得成功。手术时间65～210 min,平均110 min;术中出血量40～1500 ml,平均120 ml。膈肌损伤1例,右肾上腺中央静脉损伤1例。术后平均住院时间6d。结论腹腔入路腹腔镜下肾上腺手术是治疗大肾上腺肿瘤(直径大于5.5 cm)的理想方法。

Objective Open adrenalectomy has been almost replaced by mini-invasive surgery.This paper was to evaluate the safety and efficiency of transperitoneal laparoscopicadrenalectomy for large adrenal tumors（diameter 5.5cm）.Methods Seventy-one patients undergoing laparoscopic adrenalectomy in the First Affiliated Hospital of Zhengzhou University from February 2003 to August 2008 were reviewed retrospectively.There were 25 cases of primary hyperaldosteronism adenoma,17 cases of Cushing＇s adenoma,11 cases of phaeochromo-cytoma,8 cases of incidentoma and 10 cases of other types.The operating time,blood loss,complications and prognosis were summarized.Results Seventy patients were successfully operated,and one case were transferred to open surgery.The mean operating time was 110min（65~210）min,and blood loss was 1200ml（40~1500 ml）.The mean hospital stay was six days.One patient had diaphragm injuries,one had adrenal central vein injuries.Conclusions Transperitoneal laparoscopic adrenalectomy is a safe and feasible procedure for large adrenal masses with a diameter 5.5 cm,and open surgery is indicated when injury to major vascular or tumor adheres to surrounding tissues.