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目的探讨后腹腔镜肾上腺肿瘤切除的方法和临床应用价值。方法2002年8月～2007年12月,行后腹腔镜肾上腺肿瘤切除术401例,其中无功能腺瘤151例,原发性醛固酮增多症139例,皮质醇增多症37例,嗜铬细胞瘤19例,髓样脂肪瘤13例,其他42例。结果5例中转开放手术,其中1例瘤体过大腹腔镜操作困难,2例肿瘤与下腔静脉粘连紧密,2例出血;余396例手术成功,手术时间30～270min,平均105min,术中失血20～1000ml,中位数45ml,2例术中各出血1000、800ml,输红细胞2U。术中下腔静脉破裂1例,膈肌破裂1例,均在腹腔镜下完成修补。364例随访1～64个月,平均23.9月,无远期并发症,361例良性肿瘤未见复发。结论后腹腔镜肾上腺肿瘤切除术安全,有效,创伤小,恢复快,应为肾上腺良性疾病的首选治疗方法。
Objective To investigate the method and clinical value of retroperitoneoscopic adrenalectomy. Methods From August 2002 to December 2007, 401 patients underwent retroperitoneal laparoscopic adrenalectomy, including 151 cases of non-functioning adenoma, 139 cases of primary aldosteronism, 37 cases of cortisol hypersecretion, 19 cases, myeloid lipoma in 13 cases, the other 42 cases. Results Of the 5 cases who underwent open surgery, 1 had a tumor that was too laparoscopic and difficult to handle, 2 had a close adhesion with the inferior vena cava, and 2 had hemorrhage. Of the remaining 396 cases, the operation was successful, with a mean time of 105 to 270 min Blood loss of 20 ~ 1000ml, the median 45ml, 2 cases of intraoperative bleeding 80000ml, transfusion of red blood cells 2U. 1 case of inferior vena cava rupture, 1 case of diaphragmatic rupture, all under laparoscopic repair. 364 cases were followed up for 1 ~ 64 months, with an average of 23.9 months, no long-term complications, 361 cases of benign tumors no recurrence. Conclusions Retroperitoneal laparoscopic adrenalectomy is safe, effective, less traumatic and quicker recovery. It should be the first choice for the treatment of benign adrenal diseases.