后腹腔镜手术治疗肾上腺疾病327例回顾性分析

Treatment of adrenal tumor by retroperitoneoscopic adrenalectomy with a report of 327 cases

目的:总结后腹腔镜手术治疗肾上腺肿瘤的临床经验。方法:回顾性分析我科2008-07-01-2011-12-31行后腹腔镜手术治疗的327例肾上腺良性肿瘤病例的临床资料,其中原发性醛固酮增多症167例,皮质醇增多症79例,嗜铬细胞瘤21例,无功能肾上腺皮质腺瘤52例,肾上腺囊肿8例。对肾上腺病变类型、后腹腔镜手术的时间、出血量、并发症和预后进行总结,并对手术方法进行分析。结果:326例手术成功,1例中转开放手术。手术时间33～235min,平均66.1min;术中出血量25～950mL,平均72.6mL;术后平均住院时间5.7d。术后并发症:腹膜损伤12例,皮下气肿9例,伤口延迟愈合7例,腰部血肿5例,右肾静脉损伤1例。结论:后腹腔镜下肾上腺手术治疗安全有效,是肾上腺良性肿瘤的首选治疗方式。

OBJECTIVE：To evaluate the operative outcome of retroperitoneoscopic adrenalectomy. METHODS： From the first of July 2008 to the thirty first of December 2011 retroperitoneal adrenalectomy was conducted in 327 patients,including 167 cases of primary hyperaldosteronism adenoma,79 of Cushing＇s adenoma,21 of phaeochromocytoma, 52 of incieidentoma,and 8 of adrenal cyst. The histopathological diagnosis, operative time, blood loss, complications and prognosis were reviewed,and the different surgical approaches were compared. RESULTS： Laparoscopic surgery was accomplished in 326 out of 327 patients,while 1 patient was transferred to open surgery due to bleeding. The operative time was ranged from 33 to 235 min （average 66.1 min）. The estimated blood loss was 25--950 mL （average 72.6 mL）. The mean time of hospital-stay was 5.7 days. Postoperative complications include peritoneal injury in 12 patients, subcutaneous emphysema in 9, delayed healing of wounds in 7, retroperitoneal hematoma in 5, and right renal vein injury in 1. CONCLUSION： Retroperitoneoscopic adrenaIectomy is a safe and efficient surgical approach and can be used as the primary therapeutic method for benign adrenal tumor.