经腹腔径路腹腔镜肾上腺切除术108例手术体会及经验总结

Transperitoneal Laparoscopic Adrenalectomy for 108 Cases of Surgical Adrenal Diseases

目的总结经腹腔途径行腹腔镜肾上腺切除术治疗肾上腺外科疾病的手术体会及经验。方法 2006年6月至2012年5月,行经腹腔腹腔镜肾上腺切除术108例。男性48例,女性60例;年龄22～76岁;病变位于右侧40例,左侧63例,双侧5例;切除肿瘤/肾上腺大小0.5～11cm,平均4.5cm;其中18例有下腹部经腹腔手术史。结果除1例因膈肌损伤中转开放外,107例腹腔镜手术均顺利完成,术中出血0～200mL,平均20mL,手术时间45～150min,平均70min。术后1～2d肛门排气,2d内下床活动,术后住院时间3～7d。术后无严重并发症发生。术后病理检查:嗜铬细胞瘤38例,醛固酮腺瘤20例,原醛结节性增生6例,皮质醇增多症5例,无功能腺瘤20例,髓质脂肪瘤10例,肾上腺假性囊肿3例,节细胞神经瘤3例,肾上腺皮质癌2例,转移癌1例。结论经腹腔腹腔镜肾上腺切除术,具有手术空间大、视野清晰、解剖标志清楚、便于较早结扎处理肾上腺静脉、符合人体工效学等优点,适合于嗜铬细胞瘤、较大的肾上腺肿瘤及恶性肾上腺肿瘤等的切除。

Objective To summarize our experience in laparoscopic adrenalectomy for various surgical adrenal disorders by transperitoneal approach.Methods From June 2006 to May 2012,108 patients with surgical adrenal diseases underwent transperitoneal laparoscopic adrenalectomy,including 48 males and 60 females with age ranged from 22 to 76 years old.Lesions were located at right adrenal gland in 40 cases,left in 63 cases and bilateral in 5 cases.Tumor/adrenal size ranged from 0.5 to 11 cm（mean 4.5 cm）.Eighteen patients presented with history of previous lower abdominal operations.Results Laparoscopic adrenalectomy was successfully completed in 107 patients except one who was converted to open surgery due to diaphragm injury.Estimated blood loss was 0-200 mL（average 20 mL）.Mean operative time was 70 min（range 45-150 min）.Patients usually passed gas 1-2 days postoperatively,early ambulation occurred within 2 days after surgery,and postoperative hospital stay was 3 to 7 days.No major postoperative complications were noted.Pathological diagnoses of the adrenal gland included pheochromocytomas（38 cases）,Conn’s adenomas（20 cases）,primary hyperaldosteronism（6 cases）due to nodular hyperplasia,Cushing’s syndrome（5 cases）,non-functioning adenomas（20 cases）,myelolipomas（10 cases）,adrenal pseudocysts（3 cases）,ganglioneuromas（3 cases）,adrenal carcinomas（2 cases）,adrenal metastasis（1 case）from contralateral renal cell carcinoma.Conclusion The advantages of laparoscopic adrenalectomy by lateral transperitoneal approach include large working space,excellent view,clear anatomic landmarks,early control of adrenal vein and fitting ergonomical needs without increasing intra-abdominal morbidities.Transperitoneal approach is most suitable for pheochromocytomas,and large or malignant adrenal tumors.