腹腔镜解剖性手术治疗肾上腺肿瘤的优势及手术经验

Advantages and surgical experience of laparoscopic anatomical surgery for adrenal tumors

目的分析经腹腔途径腹腔镜解剖性手术治疗肾上腺肿瘤的优势及手术经验。方法选取2012年4月至2016年9月收治的156例肾上腺良性或恶性肿瘤患者为研究对象,均实施经腹腔途径腹腔镜解剖性手术治疗,对手术疗效及优势进行分析,探讨此类疾病的手术治疗经验。结果纳入研究的156例患者中有155例成功完成了经腹腔镜肾上腺切除手术,1例嗜铬细胞瘤患者术中因损伤膈肌形成气胸而转开放手术。术后1例发生肺栓塞,6例出现右肾上腺区域血肿,均经干预后完全缓解。54例肾上腺恶性肿瘤患者术后标本经组织病理学检测,均显示为阴性边界。术后平均随访11.6个月(4~26个月),患者的术后恢复均良好,无局部或套管针复发。结论与开放手术相比,肾上腺良恶性肿瘤患者经腹腔路径行腹腔镜肾上腺手术,手术区域大,能提供良好定位和视野,且具有住院时间短、术后并发症少、预后效果佳等优势,值得临床选择。

Objective To analyze the advantages and surgical experience of laparoscopic anatomical surgery for adrenal tumors.Methods A total of 156 patients with benign or malignant adrenal tumors admitted to our hospital from April 2012 to September 2016 were enrolled and underwent laparoscopic anatomical surgery in the study.The curative effect and advantages of the operation were analyzed,and surgical experiences of laparoscopic anatomical surgery for adrenal tumors were summarized.Results Laparoscopic adrenalectomy was successfully completed in 155 of the 156(99.4%)patients and 1 patient with pheochromocytoma underwent open surgery due to pneumothorax caused by an accidental diaphragm injury.Postoperative pulmonary embolism occurred in 1 case and hematoma in right adrenal region in 6 cases,all of whom were completely relieved after intervention.Postoperative surgical specimen of adrenal glands in 54 patients were histopathologically examined?the results of which showed the negative boundaries in all patients.Patients were followed up for a mean of 11.6 months(range,4 to 26 months).All patients had a good recovery after surgery without recurrence of malignant tumor in local or trocar site.Conclusions As compared with open surgery,the transperitoneal laparoscopic adrenal surgery provides a larger operation area for good orientation and vision,and has such advantages as shorter hospital stay,fewer postoperative complications and better prognosis in patients with malignant adrenal tumors?which is worthy of clinical selection.