机器人辅助腹腔镜手术治疗复杂性肾上腺肿瘤的初步体会(附46例报告)

Preliminary experience of robot-assisted laparoscopic surgery for complex adrenal tumors(Report of 46 cases)

目的:探讨机器人辅助腹腔镜手术治疗复杂性肾上腺肿瘤的可行性及疗效。方法:回顾性分析2014年9月～2018年6月我院收治的46例复杂性肾上腺肿瘤患者的临床资料,其中男22例,女24例;年龄21～76岁,平均47岁;左侧20例,右侧25例,双侧1例;肿瘤直径5.0～17.0cm,平均7.5cm。结果:46例手术除1例因与下腔静脉粘连紧密并突入下腔静脉后方改开放手术外,其余均行机器人辅助腹腔镜肾上腺肿瘤切除术(RALA)顺利完成。手术时间45～150min,平均65min;术中出血30～400ml,无一例术中输血;术中损伤胰尾1例,术后出现胰漏,引流3个月后自愈。术后留院3～14d,平均4d。术后病理为肾上腺腺瘤16例,肾上腺嗜铬细胞瘤12例,肾上腺髓性脂肪瘤8例,肾上腺节细胞神经纤维瘤4例,肾上腺囊肿2例,肾上腺腺癌1例,肾上腺成熟型畸胎瘤1例,肾上腺转移癌2例。术后随访2～48个月,1例肾上腺肝细胞转移癌肿瘤科靶向治疗,1例肠转移癌肿瘤科化疗,其余患者均未出现复发或转移。结论:机器人辅助腹腔镜手术治疗复杂性肾上腺肿瘤安全、有效,且成功率高,具有较明显优势。

Objective：To explore the feasibility and efficacy of robot-assisted laparoscopy in treating complex adrenal tumor.Method：The clinical data of 46 cases with complex adrenal tumors in our hospital from September 2014 to June 2018 were retrospectively analyzed,including 22 males and 24 females.The mean age of patients was 47 years old with a range from 21 to 76.There were 20 patients with left adrenal tumor,25 patients with right adrenal tumor and 1 patient with bilateral tumors.The tumor size ranged from 5 to 17 cm（mean,7.5 cm）.Result：All operations were performed successfully by robot-assisted laparoscopy except one patient who had been changed to open surgery because of adhesion with inferior vena cava and protrusion into the posterior part of inferior vena cava.The operation time was between 45 and 150 minutes,with an average of 65 minutes.The intraoperative haemorrhage ranged from 30 to 400 ml,and none of patients required intraoperative blood transfusion.One patient with pancreatic tail lesion during the operation recovered from pancreatic leakage after three months of drainage.The postoperative hospitalization time was from 3 to 14 days,with an average of 4 days.The postoperative pathology revealed 16 adrenal adenomas,12 adrenal pheochromocytomas,8 adrenomedullary lipomas,4 adrenal ganglion neurofibromas,2 adrenal cysts,1 adrenal adenocarcinoma,1 adrenal mature teratoma and 2 adrenal metastatic carcinomas.During the follow-up period of 2-48 months,no recurrence or metastasis was observed in patients,excluding one case with adrenal hepatocyte metastases followed by targeted therapy and one case with intestine metastasis treated with chemotherapy in department of oncology.Conclusion：Robot-assisted laparoscopic surgery has obvious advantages in treating complex adrenal tumors since it is safe,effective and has a high success rate.