单切口后腹腔镜治疗儿童肾上腺区肿瘤临床疗效分析

Clinical analysis of single-incision retroperitoneal laparoscopy in the treatment for adrenal tumors in children

目的:探讨单切口后腹腔镜切除儿童肾上腺区肿瘤的有效性及安全性。方法:分析2020年10月至2023年7月首都儿科研究所附属儿童医院20例单切口后腹腔镜下肾上腺区肿物切除术患儿的临床资料,其中男13例,女7例;年龄为(65.7±51.9)个月,范围在6~177个月;肿物大小为11 mm×13 mm×15 mm~50 mm×35 mm×20 mm;术前完善影像学检查,均提示为肾上腺区占位,未包绕大血管。20例患儿均接受单切口后腹腔镜下肾上腺肿物切除术。结果:所有患儿均顺利完成手术,其中4例同时行腹膜后淋巴结切除术。术中出血(9.0±5.9)ml,无术中术后输血,无中转开放手术,无一例术后转入ICU。手术切口2~4 cm,腔镜操作时间为(64.9±21.1)min。患儿术前均未留置胃肠减压管,术日或术后第1天经口进食,无呕吐、腹胀。术后住院时间为(4.8±2.3)d。随访1~24个月,无复发及转移。结论:儿童术前影像学检查明确为肾上腺区病变,无明显大血管包绕,可以行单切口后腹腔镜下肾上腺区肿物切除术,同时可行淋巴结活检术。此种术式安全有效,值得推广。

Objective:To explore the efficacy and safety of single-incision retroperitoneal laparoscopic adrenalectomy for adrenal tumors in children.Methods:From October 2020 to July 2023,the relevant clinical data were retrospectively reviewed for 20 children undergoing single incision retroperitoneal laparoscopic adrenalectomy.There were 13 boys and 7 girls with an age range of(65.7±51.9)(6-177)month.Tumor size ranged from 11×13×15 mm-50×35×20 mm.Preoperative imaging examinations revealed a space-occupying adrenal gland not surrounding great vessels.Results:All operations were completed successfully.Four of them underwent retroperitoneal lymphadenectomy simultaneously.Volume of intraoperative blood loss was(9.0±5.9)ml and there was no instance of intraoperative or postoperative blood transfusion,conversion into open surgery or postoperative transfer into intensive care unit.The surgical incision ranged from 2 to 4 cm and laparoscopic operative duration was(64.9±21.1)min.None of them had indwelling gastrointestinal decompression tube preoperatively.The postoperative hospitalization stay was(4.8±2.3)day.They resume oral intake on the day of operation or the first day postoperatively without any vomiting or abdominal distension.During a follow-up period of(1-24)months,there was no onset of recurrence or metastasis.Conclusions:Laparoscopic resection of adrenal tumors after single incision and lymph node biopsy are both safe and feasible.It is worthy of wider popularization.