腹腔镜下切除肾上腺间质性肿瘤(附27例报告)

Transperitoneal laparoscopic surgery for adrenal interstitial tissue tumors

目的:探讨经腹腹腔镜手术治疗肾上腺间质性肿瘤的适应证和可行性。方法:回顾性分析27例肾上腺间质性肿瘤患者的临床资料,行B超,CT或MRI等影像学检查,术前诊断为肾上腺囊肿10例,肾上极囊肿2例,髓性脂肪瘤7例,神经鞘瘤3例,嗜铬细胞瘤2例,肾上腺占位3例(其中错构瘤1例)。27例均行经腹腔途径腹腔镜下肾上腺肿瘤切除术,术中采用超声刀游离瘤体及肾上腺组织,行肾上腺切除时采用Hem-o-lock结扎中央静脉。结果:27例手术均顺利完成,无中转开放手术。术中2例血压出现波动,最高升至178/118mmHg(1mmHg=0.133kPa),降压处理后恢复正常。平均手术时间75(50～110)min,平均术中出血量20(10～50)ml。术后1～3d肠功能恢复,2～3d拔除引流管,无明显外科并发症,术后平均7d出院。切除肿瘤2.0cm×2.0cm×2.5cm～10.0cm×10.0cm×13.0cm,病理诊断为肾上腺囊肿12例,髓性脂肪瘤9例,神经鞘瘤5例,错构瘤1例。25例术后随访0.5～4年,复查彩超和CT未见肿瘤复发及恶性变。结论:腹腔镜手术切除肾上腺间质性肿瘤安全可靠,且创伤小、恢复快,为治疗本病的理想方法。

Objective：To evaluate the indications and feasibility of transperitoneal laparoscopic surgery for adrenal interstitial tissue tumor. Method：Twenty seven cases（11 male and 16 female,with adrenal interstitial tissue tumor） were diagnosed by B-ultrasound,CT and MRI.All patients underwent transperitoneal laparoscopic excision of adrenal interstitial tissue tumor.The ultrasonic harmonic scalpel and hem-o-lock was used during the dissociation and ligation. Result：All operations were completed successfully.The average operation time was75 min,the average blood loss was 20 ml,and the hospital stay after operation was 7 d.The tumor size was from 2.0 cm×2.0 cm×2.5 cm to 10.0 cm×10.0 cm×13.0 cm.The pathological reports showed adrenal cyst in 12 cases,adrenal myelolipoma in 9,adrenal neurilemoma in 5 and adrenal hamartoma in 1.No recurrence and carcinomatous change was detected after they were followed up for 0.5-4 years. Conclusion：It is safe and effective to perform transperitoneal laparoscopic operation for adrenal interstitial tissue tumor.