后腹腔镜下右侧巨大肾上腺肿瘤切除的手术技巧

Surgical technique of retroperitoneal laparoscopic resection for huge right adrenal mass

目的：探讨后腹腔镜下切除右侧巨大肾上腺肿瘤（最大径≥6cm）的可行性及手术技巧。方法：采用后腹腔镜下右侧巨大肾上腺肿瘤切除术治疗右侧巨大肾上腺肿瘤患者18例，肿瘤最大径为6～19（8．4±0．69）cm。术中按3个相对无血管平面分离，在腹侧平面游离时尽量将腔静脉与瘤体分开，并显露肾上腺中央静脉，在背侧平面分离时尽量向内侧中线分离，形成基于腔静脉与腰大肌之间的倒三角形肿瘤基底部。抬起瘤体，逐步向上离断汇入基底部的动脉血供，切除肿瘤。结果：除1例患者因粘连转为开放手术外，17例均顺利完成腹腔镜下肿瘤切除，手术时间80-210（147．9±7．6）min。术后病理检查报告为髓质脂肪瘤8例，嗜铬细胞瘤4例，节细胞神经纤维瘤3例，性索间质瘤1例，肾上腺囊肿伴囊壁钙化囊内出血1例。17例腹腔镜肿瘤切除手术均无术中术后输血。结论：后腹腔可以获得巨大的手术空间，术中妥善处理富含动脉血供的肿瘤基底部可以安全切除体积巨大的肿瘤。

Objective：To explore the feasibility and surgical technique of retroperitoneal laparoscopic resection for huge right adrenal mass （≥6 cm）. Method： A total of 18 patients with huge right adrenal mass whose diameter was 6-19 （8.4±0. 69） cm underwent retroperitoneal laparoscopic resection. There were three non-blood planes during surgery. We tried our best to separate ventrally the mass from the inferior vena cana in order to identify the adrenal vena, and separate dorsally adjacent to medial line. The inverted triangle mass base was created between the inferior vena and psoas. The mass was raised and blood supply of the mass base was cut gradually so as to re- sect mass. Result： All patients underwent retroperitoneal laparoscopic resection of huge right adrenal mass success- fully except that one patient was converted to open surgery because of serious adhesion. The operative time was 80-210 （147.9±7.6） min. The results of pathological examination were as follows： eight cases were found myelo- lipoma; four patients were diagnosed with pheochromocytoma; three cases were found ganglion cell neurofibroma; one patient was diagnosed with sex cord stromal tumor; another one case was found adrenal cyst with wall calcifi- cation and intracapsular bleeding. No blood tranfusion was needed during these 17 operations. Conclusion：The ra- tional and huge space may be made during the retroperitoneal laparoscopic surgery. It will be feasible to resect the huge adrenal mass if blood supply of the mass base is cut skillfully and technically.