后腹腔镜手术治疗巨大(≥6cm)肾上腺肿瘤的临床分析

Clinical Analysis of Retroperitoneal Laparoscopic Adrenalectomy for Large(≥6 cm) Adrenal Tumors

目的探讨后腹腔镜手术治疗直径≥6 cm肾上腺肿瘤的安全性及效果。方法回顾性分析2006年5月~2015年10月经后腹腔途径行肾上腺肿物切除73例的临床资料,男33例,女40例,年龄13~79岁,(46.6±16.0)岁,左侧32例,右侧41例,肿物最大径线6~15.2 cm,(8.2±2.0)cm。结果完成后腹腔镜手术70例,手术时间(159.4±64.0)min;中转开放手术3例。术中出血≤100 ml 55例,100~400 ml 11例,>400 ml 7例,输血7例。术中并发症7例,均发生在肿瘤直径>9 cm的病例中,包括膈肌损伤2例(其中1例合并腔静脉损伤大出血),腔静脉损伤出血1例,腹膜损伤4例。术后住院时间(7.5±1.2)d。术后病理肾上腺髓脂肪瘤18例,嗜铬细胞瘤16例,节细胞神经瘤9例,肾上腺皮质腺瘤5例,其他良性病变19例;肾上腺转移癌3例,恶性嗜铬细胞瘤2例,肾上腺皮质癌1例。随访3~36个月,失访14例,转移癌扩散1例,肾积水2例。结论对于有一定经验的术者,后腹腔镜手术治疗直径≥6 cm肾上腺肿瘤安全有效,其中直径>9 cm肾上腺肿瘤的手术并发症发生率较高。

Objective To evaluate the safety and efficacy of retroperitoneal laparoscopic adrenalectomy for adrenal tumors with diameter greater than or equal to 6 cm. Methods Clinical data of 73 cases who received retroperitoneal laparoscopic adrenalectomy from May 2006 to October 2015 were reviewed retrospectively,including 33 male and 40 female. The mean age was46. 6 ± 16. 0（ range,13- 79） years old. There were 32 left-sided cases and 41 right-sided cases. The mean tumor diameter size was8. 2 ± 2. 0 cm（ range,6- 15. 2 cm）. Results The operations were successfully conducted in 70 cases,with a mean operation time of（ 159. 4 ± 64. 0） min. Conversion to open surgery was required in 3 cases. The bleeding during operation was ≤ 100 ml in 55 cases,100- 400 ml in 11 cases,and 〉400 ml in 7 cases. The blood transfusion was needed in 7 cases. Complications occurred in7 cases,all of which were large tumor cases（ diameter 〉9 cm）,including 2 cases of diaphragmatic injury（ combined with hemorrhage in 1 case）,1 case of simple vena cava rupture hemorrhage,and 4 cases of peritoneal damage. The mean hospital stay after operation was 7. 5 ± 1. 2 d. Postoperative pathological outcomes included 18 cases of adrenal myelolipoma, 16 cases of pheochromocytoma,9 cases of ganglioneuroma,5 cases of adrenal cortical adenoma,19 cases of other benign lesions,3 cases of adrenal metastasis,2 cases of malignant pheochromocytoma,and 1 case of adrenal cortical carcinoma. During the follow-up for 3- 36 months,there were 14 cases of missed follow-up, 1 case of recurrence, and 2 cases of hydronephrosis. Conclusions Retroperitoneal laparoscopic adrenalectomy in the treatment of large adrenal tumors with diameter greater than or equal to 6 cm is safe and effective in experienced surgeons. The complication rate will be high in cases with tumor diameter lager than 9 cm.