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目的:探讨后腹腔镜下肾上腺解剖学特点及其对手术入路合理设计的作用。方法:通过术前CT和(或)MRI、术中观察、反复观看手术录像及文献复习,对肾上腺的解剖学特点进行研究,将后腹腔镜下肾上腺手术总结为4个步骤,第1步清理腹膜外脂肪,第2步辨认解剖标志,第3步进入相应的解剖间隙并快速找到肾上腺,第4步依术前诊断和术中情况选择肾上腺或腺瘤切除术,并以此对33例肾上腺疾病患者施行了后腹腔镜下解剖性肾上腺切除术。结果:33例手术均取得成功,术中出血少,均未输血。术后住院4～8天,平均5.3天,无严重并发症发生。结论:明确手术步骤,术中正确辨认解剖标志和解剖间隙,可以提高后腹腔镜下肾上腺手术的成功率和安全性,缩短该手术的学习曲线。
Objective: To investigate the anatomic characteristics of retroperitoneal laparoscopic adrenalectomy and its effect on rational design of surgical approach. Methods: Anatomical characteristics of the adrenal gland were studied by preoperative CT and / or MRI, intraoperative observation, repeated video recording and literature review. The retroperitoneal laparoscopic adrenalectomy was summarized as 4 steps. The first step was to clean up Extraperitoneal fat, the second step to identify anatomical landmarks, the third step into the corresponding anatomical space and quickly find the adrenal gland, the fourth step according to preoperative diagnosis and intraoperative choice of adrenalectomy or adenoma and 33 cases of adrenal gland Patients underwent retroperitoneal dissection of the adrenalectomy. Results: All the 33 surgeries were successful, less bleeding during operation and no blood transfusion. Postoperative hospital stay 4 to 8 days, an average of 5.3 days, no serious complications. Conclusion: Clear surgical procedures, correct identification of anatomical landmarks and anatomical gaps can improve the success rate and safety of retroperitoneal laparoscopic adrenal surgery and shorten the learning curve of the operation.