俯卧位背侧入路后腹腔镜肾上腺肿瘤切除术(附13例报告)

Posterior approach for retroperitoneoscopic adrenalectomy in the prone position:with a report of 13 cases

目的:探讨俯卧位背侧入路行后腹腔镜肾上腺肿瘤切除术的疗效及方法。方法:回顾分析2010年6月至2011年3月为13例患者行俯卧位经背侧入路后腹腔镜肾上腺手术的临床资料。其中男9例,女4例,35～57岁,平均45.3岁。术前均行超声、CT或MRI等检查证实为肾上腺占位性病变。病变位于左侧7例,右侧6例。原发性醛固酮增多症8例,嗜铬细胞瘤4例,无功能腺瘤1例。肿瘤直径1.3～4.2 cm,平均2.4 cm。结果:13例均顺利完成手术。手术时间65～125 min,平均89.5 min;术中出血量20～80 ml,平均45.6 ml;术后住院5～8 d,平均6.6 d。围手术期无并发症发生。随访5～14个月,平均10.5个月,未见肿瘤复发及转移。结论:俯卧位背侧入路行后腹腔镜肾上腺肿瘤切除术安全可行。经背侧入路为腹腔镜手术入路提供了新的选择。

Objective：To explore the method and efficacy of the posterior approach retroperitoneoscopic adrenalectomy in the prone position.Methods：The clinical data of 13 patients with adrenal tumors who underwent posterior approach retroperitoneoscopic adrenalectomy in the prone position from Jun.2010 to Mar.2011 were retrospectively analyzed in our hospital.There were 9 men and 4 women,and their age ranged from 35 to 57 years old,the average age was 45.3 years.All patients were diagnosed of occupation of adrenal tumors by ultrasonography,CT or MRI.7 cases of tumor position were on the left side and 6 cases of tumor position were on the right side.Of all 13 cases,there were 8 cases of primary hyperaldosteronism,4 cases of pheochromocytoma and 1 case of nonfunctioning adenoma.The diameter of tumor ranged from 1.3 to 4.2 cm,the average diameter was 2.4 cm.Results：The procedures were performed successfully in all patients.The mean operative time was 89.5 min（range from 65 to 125 min）.The blood loss was 45.6 ml（range from 20 to 80 ml）.The mean hospital stay was 6.6 days（range from 5 to 8）.No perioperative complications occurred.At a mean follow-up of 10.5 months（range from 5 to 14）.No tumor recurrence and metastasis was found in 13 cases.Conclusions：The posterior approach of retroperitoneoscopic adrenalectomy in the prone position is a safe and feasible procedure.It provides a new idea for laparoscopic surgery.