斜侧卧位肋弓下缘通道经腹腹腔镜肾上腺手术的临床价值研究

Clinical value research of transabdominal laparoscopic adrenal surgery below the costal arch access in recumbency position

目的：探讨70°斜侧卧位肋弓下缘经腹通道肾上腺手术的临床价值。方法：2010年6月-2011年6月,我院共实施肾上腺手术40例,左侧18例,右侧22例,切除肿块平均直径4.1cm,采用70°斜侧卧位经腹途径,沿肋弓下缘建立通道,右侧常规4通道,左侧3~4通道。结果：40例手术均于腹腔镜下完成,平均手术时间61.8min,术中平均失血量24.2ml,无消化道及大血管损伤等并发症,术后1-3d开始进食,术后平均住院时间6.2d。术后半年复查,所有患者切口内恢复情况良好,伴高血压患者术后完全缓解率68.2%,原发性醛固酮增多症合并低钾患者术后1个月血钾均恢复正常。结论：斜侧卧位肋缘下经腹腹腔镜肾上腺手术操作舒适性好,并发症发生率低,是一种极具可行性的腹腔镜肾上腺手术路径。

Objective：To explore the effects of transabdominal laparoscopic adrenal surgery below the costal arch access in 70°recumbency position.Method：A total of 40 patients who underwent laparoscopic adrenal surgery in 70°recumbency position were involved from June 2010 to June 2011 in our hospital.There were 18 cases on the left side and 22 cases on the right side,with the mean diameter of the lump 4.1cm.For removing the lump,conventional 4-channel was used on the right side,while channel of 3-4was used on the left side.Result：All operations were successfully performed.The mean operative time was 61.8minnutes,and the mean intraoperative blood loss was 24.2 ml.No digestive tract and vascular injuries were found.All patients began to eat 1-3days after operation.The average postoperative hospital stay was 6.2days.All patients recovered well,and the complete remission rate from hypertension was 68.2% when they were reviewed six months postoperatively.Moreover,patients of primary aldosteronism combined with hypokalemia returned to normal one month after surgery.Conclusion：Transabdominal laparoscopic adrenal surgery below the costal arch access in recumbency position is a very feasible laparoscopic adrenal surgery,which can receive high patients’ comfort and low complication rate.