腹腔镜巨大肾上腺肿瘤切除术18例报告

Laparoscopic Adrenalectomy for Large Adrenal Tumors:a Report of 18 Cases

目的：探讨腹腔镜手术切除巨大肾上腺肿瘤（直径＞6 cm）的可行性及疗效。方法2007年10月～2014年6月我科行腹腔镜巨大肾上腺肿瘤切除术18例，其中6例肾上腺肿瘤直径＜10 cm，偏向背侧生长，术前 CT 提示肿瘤边界清楚，与周围组织血管无明显浸润，采用经后腹膜腔入路，其余12例采用经腹腔入路。结果18例手术均获得成功，无中转开放手术。经后腹膜腔入路手术时间75～180 min，平均98 min；术中出血50～400 ml，平均200 ml。经腹腔入路手术时间90～210 min，平均116 min；术中出血50～1500 ml，平均275 ml，其中2例术中输血。18例术后随访3～60个月，平均30个月，1例术前有高血压术后仍有高血压，但单服钙离子拮抗剂血压可控制，余术前有高血压者术后血压均恢复正常；复查 B 超或CT 均未见肿瘤复发、转移。结论对于经验丰富且技术娴熟的外科医生，腹腔镜巨大肾上腺肿瘤切除术是安全、有效的。

Objective To evaluate the feasibility and clinical effect of laparoscopic adrenalectomy for large adrenal tumors （＆gt; 6 cm in diameter）. Methods Between October 2007 and June 2014,18 patients with large adrenal tumors underwent laparoscopic adrenalectomy in our hospital,including 6 retroperitoneal approach surgery and 12 transperitoneal approach surgery. Results The laparoscopic adrenalectomy was performed successfully in all the 18 patients,without conversion to open surgery.In the retroperitoneal approach group,the operating time was 75 -180 min （mean,98 min）,and the blood loss was 50 -400 ml （mean, 200 ml）.In the transperitoneal approach group,the operating time was 90 -210 min （mean,1 16 min）,and the blood loss was 50 -1500 ml （mean,275 ml）,including 2 patients receiving blood transfusion.During 3 -60 months of follow-up in the 18 patients,the patients with high blood pressure became normal except one.No recurrence or metastasis was found. Conclusion It is safe and effective for skilled surgeons to perform laparoscopic operation for large adrenal tumors.