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目的:探讨经腹膜后途径二次肾上腺区腹腔镜手术的可行性。方法:回顾2011年1月~2014年1月对4例有同侧经腹或经腹膜后途径腹腔镜手术史者进行经腹膜后途径二次肾上腺区腹腔镜手术,其中1例为肾上腺嗜铬细胞瘤术后复发,2例为外院肾上腺醛固酮腺瘤残留,1例为肾上腺结节样增生切除术后复发。2次手术间隔0.5~4.3年,平均2.5年。第2次手术均取经腹膜后入路,直视下经髂嵴上方2cm进入后腹腔建立气腹。分别于腋后线与12肋交点下、12肋下与腋前线交点穿刺建立操作孔道,先从解剖清晰、粘连轻处按解剖层次,逐步暴露手术部位完成手术。结果:手术均获成功,手术时间75~183min,平均101min;术中出血量50~300ml,平均136ml。1例腹膜损伤,无腹腔内脏器损伤。术后住院4~10d,平均6.8d。4例随访4~42个月,患者恢复良好,肿瘤未见复发,未见重大并发症。结论:在选择合适病例、熟练掌握后腹腔镜技术的前提下,再次后腹腔镜下肾上腺区手术是可行的。
Objective: To investigate the feasibility of retroperitoneal laparoscopic surgery in the second adrenal area. Methods: From January 2011 to January 2014, 4 patients with ipsilateral peritoneal or retroperitoneal laparoscopic surgery underwent retroperitoneal laparoscopic retroperitoneal laparoscopic surgery, of which 1 was adrenal chromaffin The tumor recurred after surgery, with 2 cases of adrenal aldosterone adenoma remaining in the hospital and 1 case of recurrence after adrenal nodular hyperplasia. 2 surgical intervals 0.5 to 4.3 years, an average of 2.5 years. The second operation were taken retroperitoneal approach, under direct iliac crest 2cm above the posterior abdominal cavity to establish pneumoperitoneum. Respectively in the axillary line and 12 ribs intersection, 12 ribs and axillary line intersection puncture to establish the operation of the tunnel, first clear anatomy, adhesions light by anatomical level, and gradually expose the surgical site to complete the operation. Results: The operation was successful. The operation time ranged from 75 to 183 minutes with an average of 101 minutes. The intraoperative blood loss was 50 to 300 ml with an average of 136 ml. 1 case of peritoneal injury, no intra-abdominal organ damage. Postoperative hospital 4 ~ 10d, an average of 6.8d. Four cases were followed up for 4 ~ 42 months. The patients recovered well and the tumor did not recur. No major complications were found. Conclusion: Under the premise of selecting appropriate cases and mastering retroperitoneal laparoscopic technique, laparoscopic adrenalectomy is feasible again.