摘要
目的:探讨经腹腔入路腔镜下巨大肾上腺肿瘤(>6 cm)程序化解剖性切除术的可行性与优势,总结其临床经验,观察其临床疗效。方法:回顾性分析2008年4月-2016年12月行经腹腹腔镜巨大肾上腺肿瘤切除术21例患者临床资料,手术方法均采用腹腔镜下经腹腔途径按"5步法"程序化解剖性切除。结果:21例手术,除1例肾上腺皮质癌患者由于肿瘤与周围组织粘连较重,术中改开放外,其余20例手术均获成功。肿瘤直径为6~12 cm,平均8.9 cm。左侧8例,右侧13例,其中嗜铬细胞瘤15例,节细胞神经瘤2例,肾上腺皮质癌2例,肾细胞癌综合征(VHL综合征)伴发肾上腺嗜铬细胞瘤1例(母亲为双侧肾上腺皮质癌),髓样脂肪瘤1例。手术时间50~190 min,平均(90.6±35.4)min,出血量30~500 mL,平均(102.6±19.2)mL,均未输血。术后住院5~14 d,平均(7.4±0.6)d。围手术期均未出现明显并发症。术后随访3~42个月,除改开放的皮质癌患者出现骨转移外,余均未见肿瘤复发。结论:经腹腔途径腹腔镜下程序化解剖性巨大肾上腺肿瘤切除术具有操作空间大、解剖清楚、操作精细、血管显露好、出血少、对肿瘤刺激性小、手术时间短、并发症少等优点,此手术方式适合巨大肾上腺肿瘤切除,安全可行。
Objective:To discuss the feasibility and advantages of the endoscopically programmed and anatomical resection of the enormous adrenal tumor with diameter of≥6 cm by transabdominal laparoscope,summarize its clinical experience and observe its clinical effectiveness.Methods:The clinical data of 21 patients undergoing the resection of the enormous adrenal tumor by transabdominal laparoscope from April of 2008 to December of 2016 in our department were analyzed,and all the operations were done via the transperitoneal approach by laparoscope following the"9-step method"of programmed and anatomical resection.Results:In the 21 cases of operations,20 of them have achieved complete success,with one case of patient suffering from adrenal cortical carcinoma whose tumor had serious synechia with surrounding tissue,which was converted to open surgery during operation.The diameter of the tumor ranged from 6 to 12 cm(mean,8.9 cm),of which 8 cases were to the left and 13 cases to the right.To be specific,there were 15 cases of pheochromocytoma,2 cases of ganglioneuroma,2 cases of adrenal cortical carcinoma,1 case of VHL syndrome concomitant with adrenal pheochromocytoma(the patient’s mother suffering from bilateral adrenal cortical carcinoma),and 1 case of myelolipoma.The operation time ranged from 50 to 190 min(mean,90.6±35.4 min),the blood loss ranged from 30 to 500 mL(mean,102.6±19.2 mL),and all operations were not given transfusion.The postoperative hospital stay varied from 5 to 14 days(mean,7.4±0.6 d).There was no obvious complication in the perioperative period.The postoperative follow-up ranging from 3 to 42 months revealed that there was no tumor recurrence except bone metastasis was found in one case of cortical carcinoma converted to open surgery.Conclusion:The endoscopically programmed and anatomical resection of the enormous adrenal tumor by transabdominal laparoscope has a series of advantages including wider operative field,clear anatomy,precise operation,good vascular exposition,less bleeding,low stimulus to the tumor,short operation time and less complication,etc.This operation method is applicable to the resection of enormous adrenal tumor,which has been proved to be safe and feasible.
作者
靳永胜
东冰
贾军琪
汪峰
张培波
李义
高继学
JIN Yongsheng;DONG Bing;JIA Junqi;WANG Feng;ZHANG Peibo;LI Yi;GAO Jixue(Department of Urology,Affiliated Hospital of Yan'an University,Yan'an 716000,China;Depart ment of Infectious Diseases,Affiliated Hospital of Yan'an University)
出处
《微创泌尿外科杂志》
2019年第5期289-293,共5页
Journal of Minimally Invasive Urology
关键词
腹腔镜
经腹腔途径
巨大肾上腺肿瘤
程序化解剖性
laparoscope
transperitoneal approach
enormous adrenal tumor
programmed and anatomical
作者简介
通信作者:高继学,2411280396@qq.com
