腹腔镜手术切除巨大肾上腺肿瘤(附15例报告)

Laparoscopic operation for large adrenal tumors(Report of 15 cases)

目的：探讨分析行腹腔镜手术切除巨大（直径＞6cm）肾上腺肿瘤的可行性和安全性。方法：回顾分析我院2008年6月~2013年6月采取经腹腔或腹膜后途径腹腔镜下切除术治疗15例巨大肾上腺肿瘤患者的临床资料。结果：15例患者手术均成功，其中采取经腹腔途径6例，采取经腹膜后途径9例，均无需中转开放手术。平均手术时间136（100~210）min，平均术中出血量134（30~500）ml，术后住院时间平均6.4（5~9）d；出现并发症1例，为下腔静脉损伤；术后病理证实为肾上腺皮质腺瘤8例，肾上腺嗜铬细胞瘤5例，髓样脂肪瘤1例，肾上腺皮质腺癌1例；失访1例，余14例获随访3~63个月，临床症状均消失，术前有高血压者血压均恢复正常，均未发现肿瘤复发或转移。结论：对于经验丰富且具有娴熟腹腔镜手术操作技巧的术者，腹腔镜手术切除巨大肾上腺肿瘤切实可行、安全有效，肿瘤大小并不是决定手术方式的主要因素。

Objective： To investigate and analyze the clinical efficacy and safety of laparoscopic operation for large adrenal tumors （diameter〉6 cm）. Method： Fifteen transperitoneal or retroperitoneal laparoscopic adrenalec- tomies were performed for patients with large adrenal tumors from June 2008 to June 2013 in our hospital. The clinical data were analyzed retrospectively. Result： Fifteen laparoscopic adrenalectomies were performed success- fully including six transperitoneal approaches and nine retroperitoneal approaches. No conversion to open surgery was found. The mean operation time was 136 （range, 100-210） rain. The mean intraoperative blood loss was 134 （range, 30-500） ml. The mean postoperative hospital stay was 6.4 （range, 5-9） d. Complication of inferior vena cava occurred in one case. Postoperative pathologic examination revealed eight adrenal cortical adenomas, five ad- renal pheochromocytomas, one myelolipoma, and one adrenocortical carcinoma. All patients except one were fol- lowed up for three to 63 months. Their clinical symptoms disappeared, and the blood pressure became normal. No recurrence or metastasis was found. Conclusion： It is safe and effective for skilled surgeons with sufficient experi- ence to perform laparoscopic operation for large adrenal tumors. However, the size of the tumor is not the crucial factor to determine the method of operation.