优先精准解剖肾上腺中央静脉在后腹腔镜肾上腺切除术中的应用

Application of Priority Precise Anatomy of Adrenal Central Vein in Retroperitoneal Laparoscopic Adrenalectomy

目的探讨后腹腔镜肾上腺切除术中优先精准解剖肾上腺中央静脉的要点及应用价值。方法回顾性分析我院2016年4月2018年6月收治的46例肾上腺肿瘤患者的临床资料,均为单侧病变,左侧肿瘤28例,右侧18例;肿瘤直径1.5~6.7 cm,平均(2.8±0.9)cm。采用腹膜后入路,术中优先精准解剖游离并酌情结扎肾上腺中央静脉,后行肾上腺切除。观察手术时间、术中出血量、腹膜后引流管留置时间、术后并发症及随访情况。结果本组46例患者均顺利完成腹腔镜手术,无中转开放手术。手术时间平均43(25~93)min,术中出血量平均20(10~50)ml,腹膜后引流管留置时间2~5 d,平均(2.8±0.6)d。所有患者术中及术后均未发生腹膜损伤、肾蒂血管损伤、腹膜后血肿、皮下血肿及切口感染等并发症。术后病理示:肾上腺腺瘤32例,皮质增生3例,嗜铬细胞瘤8例,髓样脂肪瘤2例,神经节细胞瘤1例。术后随访1年,未见肿瘤复发。结论后腹腔镜下肾上腺切除术中优先精准解剖并结扎肾上腺中央静脉,具有出血少、手术视野清晰,安全性高,值得进一步深入研究。

Objective To investigate the highlight and value of priority precise anatomy of adrenal central vein in retroperitoneal laparoscopic adrenalectomy.Methods The clinical data of 46 patients with adrenal tumors admitted from April 2016 to June 2018 were analyzed retrospectively,including 28 cases of left lateral tumor and 18 of right lateral tumor.The diameter of tumor was 1.5 to 6.7 cm with an average of(2.8±0.9)cm.All cases underwent retroperitoneal laparoscopic adrenalectomy based on precise dissection of adrenal central vein.The operation time,intraoperative blood loss,indwelling time of retroperitoneal drainage tube,postoperative complications and follow-up data were observed.Results The retroperitoneal laparoscopic adrenalectomy was completed successfully in all 46 cases without conversion to open operation.The operation time was 25 to 93 minutes with an average of 43 minutes,the blood loss was 10 to 50 ml with an average of 20 ml,and the indwelling time of the retroperitoneal drainage tube was 2 to 5 days with(2.8±0.6)days averagely.There was no obvious complication such as peritoneal injury,renal pedicle vascular injury,retroperitoneal hematoma,subcutaneous hematoma and wound infection occurred.Postoperative pathological results revealed that adenoma in 32 cases,cortex hyperplasia in 3 cases,pheochromocytoma in 8 cases,myelolipoma in 2 cases and gangliocytoma in 1 case.No recurrence was observed during one year follow-up.Conclusion The management of priority precise anatomical adrenal central vein is a safe method with less bleeding and clear surgical field in retroperitoneal laparoscopic adrenalectomy,and is worthy of further research.