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目的:探讨邻近肾门大体积肾上腺肿瘤的腹腔镜手术技巧。方法:回顾性总结分析2004年11月~2014年10月收治的155例邻近肾门大体积肾上腺肿瘤的临床诊治资料。89例采用经腹腔途径,66例采用经腹膜后途径。其中肾上腺皮质腺瘤43例(皮质醇增多症19例、原发性醛固酮增多症6例、无功能腺瘤18例)、肾上腺嗜铬细胞瘤65例、肾上腺髓性脂肪瘤23例、节细胞神经瘤16例、肾上腺皮质癌8例。肿瘤直径平均7.5cm,观察手术时间、术中出血量、术中术后并发症、肠道恢复时间及术后住院时间等。结果:手术均获成功,手术时间平均75min,术中出血量平均15ml,术后肠道恢复时间平均28h,术后住院时间平均7d。2例患者出现皮下气肿,未予处理,术后2~3d自行吸收。1例多发性内分泌腺瘤患者双侧同期手术术后出现急性肾上腺皮质功能危象经过及时补充大剂量肾上腺皮质激素以及支持治疗后治愈。随访3个月~10年,未见肿瘤复发。结论:经腹腔或经腹膜后途经腹腔镜肾上腺肿瘤切除术治疗临近肾门的大体积肾上腺肿瘤安全可行、创伤小且手术效果好,但手术较复杂,术者需具有熟练的腹腔镜技术,术前需准备充分。
Objective: To explore the technique of laparoscopic surgery of large adjacent adrenal nephromas. Methods: The clinical data of 155 cases of large adrenal neoplasms adjacent to the renal hilus admitted from November 2004 to October 2014 were retrospectively analyzed. 89 cases were treated by transperitoneal approach and 66 cases were treated by retroperitoneal approach. Among them, 43 cases of adrenocortical adenoma (19 cases of cortisolism, 6 cases of primary aldosteronism, 18 cases of non-functioning adenoma), 65 cases of adrenal pheochromocytoma, 23 cases of adrenal lipoma, Neuroma in 16 cases, 8 cases of adrenal cortical cancer. The average tumor diameter was 7.5cm. The operation time, intraoperative blood loss, intraoperative and postoperative complications, intestinal recovery time and postoperative hospital stay were observed. Results: All the operations were successful. The average operation time was 75 minutes. The average amount of blood loss during operation was 15ml. The average postoperative intestinal recovery time was 28 hours. The average postoperative hospital stay was 7 days. 2 patients showed subcutaneous emphysema, untreated, after 2 ~ 3d self-absorption. A case of multiple endocrine neoplasia patients with bilateral simultaneous surgery after acute crisis of adrenal function after timely replenishment of large doses of adrenocorticotropic hormone and supportive treatment after cure. Follow-up 3 months to 10 years, no tumor recurrence. CONCLUSIONS: Transabdominal or transperitoneal laparoscopic adrenalectomy for the treatment of massive adrenal neoplasms near the renal hilar is safe and feasible with minimal trauma and good surgical outcomes. However, the surgery is complicated and requires a skilled laparoscopic technique Before the need to fully prepared.