肾蒂标志法在腹腔镜手术治疗复杂肾上腺肿瘤中的应用

Application of renal pedicle marking in laparoscopic surgery for complex adrenal tumors

目的:探讨肾蒂标志法在腹腔镜手术治疗复杂肾上腺肿瘤中的安全性和有效性.方法:回顾性分析2019年1月~2021年10月期间,我院收治的20例复杂肾上腺肿瘤患者临床资料,其中男9例,女11例;年龄30~61岁,平均46.7岁;左侧12例,右侧8例;术前确诊高血压患者11例,肿瘤直径1.5-11cm,平均4.2cm.肿瘤边缘离肾蒂的距离1.5-39.6mm,平均9.5mm,CT示肾上腺肿瘤与周围组织有粘连的10例.结果:20例腹腔镜下肾上腺肿瘤切除术,中转开放0例,手术时间1.8~5.5h,平均3.1h;术中出血10~100mL,0例术中输血;术中及术后并发症情况出现0例.术后住院4~10d,平均5.8d.术后病理类型:按病理科类型进行分类统计,肾上腺皮质腺瘤10例,肾上腺嗜铬细胞瘤4例,皮质腺癌2例,肾上腺囊肿2例,神经鞘瘤1例,节细胞神经瘤1例,髓脂肪瘤1例.术后随访1月,术后1月内,再次手术者0例,再次入院者0例,出院后出现低钾血症患者1例,术后血压恢复正常者7例.结论:采用肾蒂标志法在腹腔镜手术治疗复杂肾上腺肿瘤具有解剖标志明确、安全、有效,具有一定的推广价值.

Objective To evaluate the safety and efficacy of renal pedicle marking in laparoscopic surgery for complex adrenal tumors.Methods The clinical data of 20 patients with complex adrenal tumors treated in our hospital from January 2019 to October 2021 were analyzed retrospectively,including 9 males and 11 females,aged from 30 to 61 years(mean 46.7 years),12 on the left side and 8 on the right side.11 patients with hypertension were diagnosed before operation,the tumor diameter was 1.5-11cm,the average 4.2cm.The distance between the edge of the tumor and the renal pedicle was 1.5-39.6mm,with an average 9.5mm.Ct showed adhesion between adrenal tumor and surrounding tissue in 10 cases.Results Among the 20 cases of laparoscopic adrenalectomy,0 cases were converted to open adrenalectomy,the operation time was 1.8-5.5 h,with an average of 3.1 h,intraoperative blood transfusion was found in 0 cases,and intraoperative and postoperative complications occurred in 0 cases.Postoperative hospital stay ranged from 4 to 10 days,with an average of 5.8 days.According to the pathological types,there were 10 cases of adrenocortical adenoma,4 cases of adrenal pheochromocytoma,2 cases of cortical adenocarcinoma,2 cases of adrenal cyst,1 case of neurilemmoma,1 case of ganglion cell neuroma and 1 case of myelolipoma.The patients were followed up for 1 month.Within 1 month after operation,there were 0 cases of re-operation,0 cases of re-admission,1 case of hypokalemia after discharge and 7 cases of normal blood pressure after operation.Conclusion The method of renal pedicle marking in laparoscopic surgery for complex adrenal tumors is clear,safe and effective,and has a certain popularizing value.