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目的:了解腹腔镜肾上腺切除术(laparoscopic adrenalectomy,LA)和开放肾上腺切除术(open adrenalectomy,OA)治疗肾上腺巨大(>6cm)良性肿瘤的差别。方法:分析2009年1月~2011年12月手术治疗的50例肾上腺巨大良性肿瘤的临床特点。其中LA组26例,OA组24例。比较两组年龄、肿瘤大小、手术时间、术中出血量、住院时间、切口长度;LA组嗜铬细胞瘤切除6例,OA组嗜铬细胞瘤切除7例,比较两者术中血流动力学变化。结果:术后病理为肾上腺腺瘤2例,节细胞神经瘤10例,嗜铬细胞瘤13例,髓样脂肪瘤19例,肾上腺囊肿伴出血3例,神经鞘膜瘤2例,肾上腺巨淋巴结增生(Castleman病)1例。LA组和OA组比较,平均年龄分别为(45.3±15.6)岁和(52.2±13.2)岁(P=0.069);肿瘤直径分别为(7.75±1.26)cm和(8.38±1.96)cm(P=0.098);平均手术时间分别为(65.2±23.4)min和(126.9±32.5)min(P<0.01);出血量分别为(54.1±19.5)ml和(205.0±49.6)ml(P<0.01);住院时间分别为(4.8±1.6)d和(7.6±2.1)d(P<0.01);切口长度分别为(7.56±2.06)cm和(18.28±3.25)cm(P<0.01)。LA组无一例发生手术相关并发症或中转开放;OA组因肾血管损伤行一侧肾切除1例。LA组切除嗜铬细胞瘤术中最高收缩压和心率低于OA组(P<0.05)。术后随访3~26个月,肿瘤无复发。结论:尽管LA需要延长切口取出肿瘤,但与OA相比,切除肾上腺巨大良性肿瘤仍具有手术时间短、出血少、创伤小、恢复快等优势。
OBJECTIVE: To understand the difference between laparoscopic adrenalectomy (LA) and open adrenalectomy (OA) in the treatment of huge (> 6cm) benign tumors of the adrenal gland. Methods: The clinical features of 50 cases of giant benign adrenal tumors surgically treated from January 2009 to December 2011 were analyzed. Among them, 26 cases in LA group and 24 cases in OA group. The age, tumor size, operation time, intraoperative blood loss, length of hospital stay and incision length were compared between the two groups. Six cases of pheochromocytoma in LA group and seven cases of pheochromocytoma in OA group were compared. The intraoperative hemodynamic variables Learning changes. Results: Postoperative pathology was 2 cases of adrenal adenoma, 10 cases of ganglioneuroma, 13 cases of pheochromocytoma, 19 cases of myeloid lipoma, 3 cases of adrenal cyst with hemorrhage, 2 cases of nerve sheath tumor, adrenal giant lymph node 1 case of Castleman’s disease. The mean age was (45.3 ± 15.6) years old and (52.2 ± 13.2) years old (P = 0.069) respectively in LA group and OA group. The tumor diameter were (7.75 ± 1.26) cm and (8.38 ± 1.96) cm The average operative time was (65.2 ± 23.4) min and (126.9 ± 32.5) min respectively (P <0.01). The bleeding volume was 54.1 ± 19.5 and 205.0 ± 49.6 respectively (P <0.01). The duration of hospital stay was (4.8 ± 1.6) d and (7.6 ± 2.1) d, respectively (P <0.01). The length of incision was (7.56 ± 2.06) cm and (18.28 ± 3.25) cm respectively (P <0.01). None of the cases in LA group had surgery-related complications or were switched to open surgery. In the OA group, one-sided nephrectomy was performed due to renal vascular injury. In the LA group, the highest intraoperative systolic pressure and heart rate were lower in patients with pheochromocytoma than those in the OA group (P <0.05). All cases were followed up for 3 to 26 months without recurrence of tumor. CONCLUSION: Although LA requires an extended incision to remove the tumor, resection of a giant benign tumor of the adrenal gland still has the advantages of shorter operation time, less bleeding, less trauma and faster recovery than OA.