经腹膜后入路腹腔镜下肾上腺血管瘤切除术的临床经验分享

Retroperitoneal laparoscopic adrenalectomy for adrenal hemangioma:clinical experience

目的:总结经腹膜后入路腹腔镜下肾上腺血管瘤切除术的手术经验。方法:回顾分析2014年5月至2016年12月收治的5例术后病理证实肾上腺血管瘤患者的临床资料,其中男1例,女4例,中位年龄42(27~67)岁;中位肿瘤直径3.5(2.4~4.5)cm,左侧2例,右侧3例;术前CT提示5例肿瘤均为囊实性、边界清,2例肿瘤内可见明显多处钙化。5例患者均行后腹腔镜肾上腺肿瘤切除术。结果:5例手术均顺利完成,无一例中转开放,术中、术后无严重并发症发生。中位手术时间65(50~90)min,术中出血量<50 mL,术后中位住院时间4(3~6)d;术后病理结果提示,5例均为肾上腺血管瘤;术后中位随访时间15(9~36)个月,患者恢复情况良好,无激素不足等症状出现,随访期间均未见肿瘤局部复发。结论:肾上腺血管瘤是较罕见的肾上腺良性肿瘤,术前影像学检查明确困难,术后病理为金标准。后腹腔镜肾上腺肿瘤切除术治疗肾上腺血管瘤可行、安全、有效,值得临床推广应用。

Objective:To summarize the experience of retroperitoneal adrenalectomy for adrenal hemangioma.Methods:A retrospective analysis was made on the clinical data of 5 patients who suffered from adrenal hemangioma and underwent retroperitoneal adrenalectomy during the period of May 2014 to Dec.2016.Thereinto,1 case was male and 4 cases were female.The median age was 42(27-67)years old.The median tumor diameter was 3.5(2.4-4.5)cm.In 2 cases the tumor located in left adrenal gland,and in 3 cases located in right.Preoperative CT showed that tumors in all cases were solid-cystic with clear border.Tumors in 2 cases had significantly calcification.5 patients underwent retroperitoneal laparoscopic adrenal tumor resection.Results:The operations of all patients were completed successfully,without conversion to open surgery or serious complications during the intraoperative and postoperative period.The median operation time was 65(50-90)min.The average intraoperative blood loss was less than 50 mL.The median postoperative hospital stay was 4(3-6)d.Postoperative pathological results showed that 5 cases were adrenal hemangioma.After follow-up of 15(9-36)months,all patients recovered well.There were no symptoms of hormone deficiency,tumor local recurrence or distant metastasis during the follow-up period.Conclusions:Adrenal hemangioma is a rare benign adrenal tumor,preoperative imaging examination is difficult to diagnose,and postoperative pathology is the gold standard for diagnosis.The retroperitoneal laparoscopic adrenal tumor resection is feasible,safe and effective in the treatment of adrenal hemangioma,and this technology is worthy of clinical application.