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目的:介绍后腹腔镜解剖性肾上腺醛固酮瘤切除术的手术方法及临床效果。方法:2011年8月至2012年12月,对13例患者采取后腹腔镜解剖性肾上腺醛固酮瘤切除术,其中左侧病变7例,右侧病变6例,均为单侧单发腺瘤,肿瘤大小0.6~3.0(1.65±0.62)cm。常规制备后腹腔操作空间,切开Gerota筋膜后,按顺序分别进入3个相对无血管解剖层面进行分离。第一分离层面位于肾脏内上方脂肪囊与前层Gerota筋膜之间;第二分离层面位于肾外上方脂肪囊与后层Gerota筋膜之间;第三分离层面位于肾上腺下方与肾上极之间,行肾上腺全切或部分切除术。结果:手术均成功完成,平均手术时间(63±20)min,平均术中出血量66±29 mL。恢复饮食和下床活动时间分别为1.2 d和1.0 d。1例出现术后引流液增多,1周后拔管。术后1个月复查电解质和醛固酮水平基本恢复正常,6个月后复查血压均正常。结论:后腹腔镜解剖性肾上腺微小肿瘤手术解剖层次清楚,术野清晰。肾上腺部分切除可以治愈醛固酮瘤,疗效确切。解剖性肾上腺部分切除手术为肾上腺醛固酮疾病的治疗提供了更加安全的选择。
Objective: To introduce the surgical method and clinical effect of retroperitoneoscopic anatomic adrenal aldosterone tumor resection. Methods: From August 2011 to December 2012, 13 cases underwent laparoscopic anatomical adrenal aldosteronoma resection, including 7 cases of left lesion and 6 cases of right lesion, all of which were unilateral single adenoma, Tumor size ranged from 0.6 to 3.0 (1.65 ± 0.62) cm. Conventional preparation of posterior abdominal space, Gerota fascia incision, respectively, in order to enter the three relative non-vascular anatomical separation. The first level of separation is located between the upper fat balloon and the Gerota fascia in the kidney. The second level of separation is between the superior fat balloon and the posterior Gerota fascia. The third separation level is located below the adrenal gland Between the line adrenalectomy or partial resection. Results: The operation was completed successfully. The average operation time was 63 ± 20 min, with an average blood loss of 66 ± 29 mL. Restoration diet and ambulation time were 1.2 d and 1.0 d respectively. 1 case of postoperative drainage increased, extubation after 1 week. Electrolytes and aldosterone levels returned to normal one month after surgery, and blood pressure was normal after 6 months. Conclusions: The retroperitoneal dissection of adrenal gland micro-tumor has a clear anatomy level and clear operative field. Partial adrenalectomy can cure aldosterone tumor, the exact effect. Anatomical partial adrenalectomy offers a safer option for the treatment of adrenal aldosterone disease.