后腹腔镜手术在治疗肾上腺疾病中的价值(附21例报告)

EVALUATION OF RETROPERITONEAL LAPAROSCOPIC SURGERY IN THE TREATMENT OF ADRENAL DISEASES(REPORT OF 21 CASES)

目的 :应用后腹腔镜手术治疗肾上腺疾病并评价其临床价值。方法 :2 0 0 1年 9月～ 2 0 0 2年 11月间 ,采用后腹腔镜手术治疗各类肾上腺疾病 2 1例 ,包括 11例原发性醛固酮增多症、4例无功能性腺瘤、3例皮质醇增多症、2例骨髓脂肪瘤和 1例嗜铬细胞瘤。病变位于左侧 14例 ,右侧 7例。全部病例均采用腹膜后径路。结果 :2 1例手术均获成功。前 10例手术时间 110～ 2 3 0min ,平均 167min ;后 11例手术时间 45～ 2 2 0min ,平均114min。术中出血 10～ 80ml,平均 2 18ml,未输血。术后平均住院日 5.8d。无 1例出现膈肌损伤、切口感染等并发症。结论 :后腹腔镜手术具有损伤小、切口美观、胃肠干扰少、恢复快和住院时间短等优点 。

Objective:To evaluate the clinical application of retroperitoneal laparoscopic surgery for adrenal diseases. Methods:Twenty-first patients with adrenal diseases underwent la paroscopic surgery by the retroperitoneal approach from Sep 2001 to Nov 2002. O f the patients, 14 were on the left side and 7 on the right. There were 11 cases of primary aldosteronism, 4 cases of nonfunctional adenoma, 3 cases of Cushing' s syndrome (2 adrenal adenomas and 1 cortex hyperplasia), 2 cases of myelolipoma , and 1 case of pheochromocytoma.Results:All operations were performed successfully. The mean ope rative time for the first 10 procedures was 167 minutes and 114 minutes for the second 11 ones. Blood loss during the procedures was 10～80 ml with no need of b lood transfusion. There were no severe intra- and postoperative complications su ch as diaphragm damage and wound infection. The average postoperative hospital d ay was 5.8 days.Conclusion:Retroperitoneal laparoscopic adrenalectomy has a dvantages of minimal morbidity, small incision, less gastrointestinal interferen ce and rapid recovery. This method could be considered as the surgical treatment of choice for adrenal diseases.