后腹腔镜肾上腺部分切除术治疗库欣综合征肾上腺皮质腺瘤的临床研究

Clinical investigation on retroperitoneal laparoscopic partial adrenalectomy for the treatment of Cushing's syndrome caused by adrenocortical adenoma

目的探讨后腹腔镜肾上腺部分切除术治疗库欣综合症肾上腺皮质腺瘤的有效性和安全性。方法 2005年1月到2010年12月共有60例库欣综合症肾上腺皮质腺瘤的患者在我院行后腹腔镜肾上腺手术,其中54例行后腹腔镜肾上腺部分切除术。回顾性分析患者住院资料和随访资料。结果后腹腔镜肾上腺手术平均耗时80min,出血量64mL,术后住院7d。手术成功率达96.4%。术前伴发疾病在术后有不同程度改善,高血压、糖尿病和肥胖的缓解率分别为54.8%、29.4%和58.6%。1例患者在围术期发生死亡。结论后腹腔镜肾上腺部分切除术治疗库欣综合症肾上腺皮质腺瘤安全有效,伴发疾病在术后有不同程度的缓解。瘤体大小是影响手术方式的重要因素。

Objective To present our experience with retroperitoneal laparoscopic partial adrenalectomy for the treatment of Cushing＇s syndrome caused by adrenocortical adenoma. Methods A total of 60 patients who underwent retroperitoneal laparoscopic adrenal surgery for Cushing＇s adenoma in our institution from Jan. 2005 to Dec. 2010 were enrolled in this study. Preoperative, intraoperative, and postoperative variables were reviewed. Results The mean operative time was 80min with a mean blood loss of 64 mL. The success rate of the surgery in our series was 96.4%. Hypertension was relieved in 23 of 42 patients （54.8%）, diabetes in 5 of 17 patients （29.4%） and obesity in 17 of 29 patients （58.6%）. One patient died after surgery. Conclusions Retroperitoneal laparoscopic partial adrenalectomy can achieve an excellent outcome for the treatment of Cushing＇s syndrome caused by adrenocortical adenoma with extremely low morbidity. Tumor size is an important factor affecting the surgical method.