两种入路保留肾上腺的腹腔镜肾上腺肿瘤切除术的比较

Comparison of two different approaches for laparoscopic adrenal-sparing surgery for adrenal tumor

目的探讨腹腔镜肾上腺保留手术的适应证,评估其可行性、手术意义及不同手术路径之间差异。方法选取2015年1月至2017年8月安徽医科大学第二附属医院收治肾上腺疾患的病例资料,报告其中54例肾上腺良性肿瘤行腹腔镜保留肾上腺手术(27例行腹腔途径,27例经腹膜后途径),观察围手术期指标、手术效果,比较两种手术路径的差异。结果 54例行保留肾上腺腹腔镜肿瘤切除术。经腹腔途径平均手术时间(52.4±11.4)min,术中平均出血量(32.8±7.7)ml;后腹腔途径平均手术时间(68.4±12.6)min,术中平均出血量(41.3±8.1)ml。54例共切除肿瘤59枚。病理报告:肾上腺皮质腺瘤34例(其中醛固酮瘤16例,皮质醇腺瘤7例,无功能腺瘤11例),嗜铬细胞瘤8例,髓质脂肪瘤5例,皮质结节增生3例,髓质增生1例,淋巴管瘤1例,神经纤维瘤1例,神经鞘瘤1例。术后随访平均13个月(3~24个月),未见肿瘤复发。有高血压症状的31例患者26例血压恢复正常,其余5例需服用小剂量降压药。6例皮质醇增多症的患者中4例已停止激素补充,2例仍需小剂量补充糖皮质激素。结论腹腔镜保留肾上腺手术治疗肾上腺良性肿瘤是一个安全合适的选择,经腹腔途径行保留肾上腺手术在缩短手术时间,减少术中出血量较后腹腔途径具有一定优势。

Objective To investigate the indications,feasibility and surgical significance between different surgical approaches for laparoscopic adrenal-sparing surgery for adrenal tumors.Methods The patients with adrenal diseases in the Second Affiliated Hospital of Anhui Medical University were selected from January 2015 to August 2017.Fifty-four cases with benign adrenal tumor were treated with laparoscopic adrenal-sparing surgery(27 patients were treated by transperitoneal approach and 27 patients retroperitoneal approach).The indexes of perioperative period,the effect of operation,and the difference between two approaches were observed and compared.Results Fifty-four cases underwent laparoscopic with adrenal-sparing surgery.The mean operative time was(52.4±11.4)min and the mean intraoperative bleeding was(32.8±7.7)ml in transperitoneal group.The mean operative time was(68.4±12.6)min and the average intraoperative bleeding was(41.3±8.1)ml in retroperitoneal group.Fifty-nine tumors were resected in 54 cases.Pathology showed adenoma in 34 patients(including 16 cases of aldosteronoma,7 cases of cortisol adenoma and 11 cases of nonfunctional adenoma),pheochromocytoma in 8 patients,myelolipoma in 5 patients,adrenocortical nodular hyperplasia in 3 patients,medullary hyperplasia in 1 patient,angiolymphoma in 1 patient,neurofibroma in 1 patient,schwannoglioma in 1 patient.All patients were followed up for an average of 13 months(from 3 to 24 months)without tumor recurrence.The blood pressure of 26 patients with hypertension returned to be normal,and the remaining 5 cases needed to take small doses of antihypertensive drugs.Four cases of hypercortisolism had stopped hormone supplement and 2 cases still needed a small dose of glucocorticoid.Conclusion Laparoscopic adrenal-sparing surgery is a safe and appropriate option for the treatment of benign adrenal tumors.The transperitoneal approach has some advantages over retroperitoneal approach in shortening the operative time and reducing the amount of intraoperative bleeding.