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目的:探讨巨大左侧肾上腺肿瘤切除的手术技巧,并分析术中损伤脾脏、胰腺的可能原因。方法:回顾性分析我院于2009年2月～2012年7月间收治的7例巨大左侧肾上腺肿瘤患者的临床资料。结果:行经腹左侧肋缘下切口4例,腹部Chevron切口3例。肿瘤直径10～23cm,平均16.7cm。手术时间平均323.8min(150～404min);术中估计失血量平均1 140ml(400～2 600ml),术中输血量平均680ml(0～1 600ml)。术后病理报告提示恶性嗜铬细胞瘤2例,嗜铬细胞瘤2例,肾上腺皮质腺癌1例,肾上腺皮质腺瘤1例,成熟性畸胎瘤1例。围手术期无患者死亡。术中出现脾脏损伤1例,胰腺损伤1例。术后无急性胰腺炎、急性肾功能衰竭、深静脉血栓形成等严重并发症发生。结论:经腹肋缘下切口和腹部Chevron切口对于切除巨大左侧肾上腺肿瘤可获得良好暴露。脾胰整体翻转可直视下切除肿瘤,有利于缩短手术时间,并减少术中术后并发症。
Objective: To explore the surgical technique of giant left adrenal tumor resection and analyze the possible causes of intraoperative injury of the spleen and pancreas. Methods: The clinical data of 7 patients with giant left adrenal tumors admitted in our hospital from February 2009 to July 2012 were analyzed retrospectively. Results: Four cases underwent abdominal incision on the left margin and three cases underwent abdominal Chevron incision. Tumor diameter 10 ~ 23cm, an average of 16.7cm. The mean operative time was 323.8 minutes (150-404 minutes). The average blood loss during operation was 1 140ml (400-2,600ml). The mean amount of blood transfusions during surgery was 680ml (0-1,600ml). Postoperative pathology report showed 2 cases of malignant pheochromocytoma, 2 cases of pheochromocytoma, 1 case of adrenocortical adenocarcinoma, 1 case of adrenocortical adenoma and 1 case of mature teratoma. Perioperative no patient died. One case of spleen injury and one case of pancreatic injury occurred during operation. No postoperative acute pancreatitis, acute renal failure, deep venous thrombosis and other serious complications. CONCLUSIONS: Transabdominal incision and abdominal Chevron incision provide good exposure to resection of large left adrenal tumors. Whole spleen and pancreas can be directly under the tumor resection, is conducive to shortening the operation time and reduce intraoperative and postoperative complications.