俯卧位经背侧腹腔镜肾上腺肿瘤切除术的有效性及安全性分析

The efficacy and safety of posterior retroperitoneoscopic adrenalectomy in the prone position

目的探讨俯卧位经背侧腹腔镜肾上腺肿瘤切除术的有效性及安全性。方法回顾性分析南京医科大学附属苏州医院2019年1月至2021年2月收治的74例行俯卧位经背侧腹腔镜肾上腺肿瘤切除术患者的临床资料。男36例,女38例;年龄(54.4±12.5)岁;体质量指数(24.03±3.5)kg/m^(2)。术前均行肾上腺CT检查,其中肾上腺肿瘤左侧39例,右侧33例,双侧2例;肿瘤直径(2.4±1.3)cm;术前诊断肾上腺无功能性肿瘤22例,原发性醛固酮增多症21例,库欣综合征8例,嗜铬细胞瘤23例。74例(76侧)均行俯卧位经背侧腹腔镜肾上腺肿瘤切除术。分析患者围手术期指标及术后随访情况。结果74例(76侧)均顺利完成手术。其中,42例行单侧肾上腺切除术,30例行单侧肾上腺部分切除术,2例双侧肿瘤者均行肾上腺全切除术。手术时间为(53.2±16.1)min(2例双侧者分别为70、115min);引流管留置时间中位值3(0,4)d;术后住院时间(4.2±0.9)d。病理诊断为肾上腺皮质腺瘤32例,肾上腺皮质增生结节8例,肾上腺囊肿5例,髓质脂肪瘤7例,嗜铬细胞瘤22例。围手术期无明显并发症发生。术后随访(12.5±2.7)个月,无肿瘤复发及远期并发症发生。结论俯卧位经背侧腹腔镜肾上腺肿瘤切除术具有出血和渗出量少、术后恢复快等优势,是治疗中小肾上腺肿瘤的一种安全有效的手术方式。

Objective To explore the efficacy and safety of posterior retroperitoneoscopic adrenalectomy(PRA)in the prone position.Methods The clinical data of 74 patients who underwent PRA in the prone position in our hospital from January 2019 to February 2021 were reviewed.There were 36 males and 38 females,with an average age was(54.4±12.5)years old.The body mass index was(24.03±3.5)kg/m^(2).CT scans of the adrenal glands were performed before operation.There were 39 cases of adrenal tumors on the left side,33 cases on the right side,and 2 cases on both sides.The diameter of adrenal tumors shown on CT was(2.4±1.3)cm.Among them,22 cases were diagnosed of non-functional adrenal tumors,21 cases were primary aldosteronism,8 cases were Cushing syndrome,and 23 cases were pheochromocytoma.The PRA in the prone position were performed in all 74 patients(76 sides).Results The operation was performed successfully in all 74 patients(76 sides),of which 42 cases underwent unilateral adrenalectomy,30 cases underwent unilateral partial adrenalectomy and 2 cases underwent bilateral adrenalectomy.The operation time was(53.2±16.1)min for 76 sides,and the time of two bilateral cases was 70 min and 115 min respectively.The median time of rainage tube indwelling was 3(0,4)d,and the hospital stay was(4.2±0.9)d.The pathological diagnosis:there were 32 cases of adrenal cortical adenoma,8 cases of adrenal cortical hyperplasia nodule,5 cases of adrenal cyst,7 cases of adrenal medullary lipoma,and 22 cases of adrenal pheochromocytoma.No adverse complications occurred during the perioperative period.The patients were followed-up for(12.5±2.7)months,and no tumor recurrence or long-term complications occurred.Conclusions Posterior retroperitoneoscopic adrenalectomy in the prone position has the advantages of reducing bleeding and exudation,and rapid recovery after surgery,which provides a safe and effective surgical method for the treatment of adrenal tumors.