腹腔镜手术治疗肾上腺疾病

Experience with laparoscopic surgery for adrenal diseases

目的 :应用腹腔镜技术治疗肾上腺疾病 ,并评价其临床价值。 方法 :采用腹腔镜技术治疗各类肾上腺疾病 12例。疾病种类包括原发性醛固酮增多症、皮质醇增多症、无功能性腺瘤、髓性脂肪瘤和嗜铬细胞瘤。全部病例均采用腹膜后径路。 结果 :12例手术均获成功。前 6例手术时间 130～ 2 30 (平均 172 )min ;后 6例手术时间10 0～ 2 2 0 (平均 14 7)min。术中出血 10～ 6 0 (平均 15 .8)ml,未输血。术后平均住院日 5 .6天。无一例出现膈肌损伤、切口感染等并发症。 结论 :与开放手术相比 ,腹腔镜下肾上腺手术具有损伤小、切口美观、患者恢复快和住院时间短等优点 ,可作为肾上腺疾病的首选治疗方法。

Objectives:To evaluate the clinical application of retroperitoneal laparoscopic surgery for adrenal diseases. Methods: Twelve patients with adrenal diseases underwent laparoscopic surgery by the retroperitoneal approach. Of the 12 cases, 8 were on the left side and 4 on the right. There were 6 cases of primary aldosteronism, 2 cases of Cushing's syndrome (1 adrenal adenoma and 1 cortex hyperplasia), 2 cases of nonfunctional adenoma, 1 case of myelolipoma, and 1 case of pheochromocytoma. Results: All operations were performed successfully. There were no severe intra- and postoperative complications such as diaphragm damage, wound infection and subcutaneous emphysema. The mean operative time for the first 6 procedures was 172 minutes and 147 minutes for the second 6 ones. The average postoperative hospital day was 5.6 days. Conclusions:Comparing to the open surgery, laparoscopic adrenalectomy via the retroperitoneal approach has advantages of minimal morbidity, small incision and rapid recovery. This method could be considered as an alternative treatmant for adrenal diseases.