腹腔镜经腹膜后解剖性肾上腺(腺瘤)切除术的体会

The experiences of retroperitoneal laparoscopic anatomical adrenalectomy(adrenal adenoma resection)

目的:探讨腹腔镜经腹膜后解剖性肾上腺(腺瘤)切除术的手术方法及临床效果。方法:为48例患者按既定手术步骤施行解剖性肾上腺(腺瘤)切除术。制备腹膜后腔操作空间后,先将肾上极腹膜外脂肪向下推至髂窝,然后避开腹膜返折纵行切开肾后筋膜外层,进入肾周筋膜固有间隙,扩大腹膜后腔,并在此间隙快速找到肾上腺,根据术前诊断及术中情况选择行肾上腺或腺瘤切除术。结果:48例手术均获成功,术中出血少,均未输血,无严重并发症发生。术后住院4～8 d,平均5.2 d。结论:腹腔镜经腹膜后解剖性肾上腺(腺瘤)切除术步骤明确,解剖层次清晰,疗效确切,为肾上腺疾病的微创外科治疗提供了更安全的选择。

Objective： To assess the surgical method and clinical efficacy of retroperitoneal laparoscopic anatomical adrenalectomy（adrenal adenoma resection）. Methods：Anatomical adrenalectomy were performed for 48 patients according to the established surgical procedure.After preparing the retroperitoneal operation space,the extraperitoneal fat of the upper pole of kidney should be pushed down to iliac fossa firstly,then the outer layer of retrorenal fascia was longitudinally cut to avoid the peritoneal reflection and the natural space of the fascia around the kidney was entered into,the retroperitoneum was enlarged and the adrenal gland was found out,adrenalectomy or adrenal adenoma resection was performed according to the pre-operative diagnosis and intraoperative situation. Results：All operations were successful with less blood loss,no blood transfusion or serious complications occurred.The hospital stay ranged from 4 d to 8 d with 5.2 d on the average. Conclusions：The retroperitoneal laparoscopic anatomical adrenalectomy（adrenal adenoma resection） procedure is precise,the anatomic structure is clear,and the curative effect is reliable,which provides a more secure choice for the minimally invasive surgical treatment of adrenal diseases.