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目的探讨腹腔镜下切除巨大肾上腺肿瘤的可行性及手术技巧。方法回顾性分析内蒙古鄂尔多斯市中心医院2010年1月至2016年12月经腹腔或腹膜后途径腹腔镜下切除术治疗9例巨大肾上腺肿瘤患者的临床资料,总结手术技巧。结果 8例患者中7例有临床症状,2例为无症状肿瘤。肿瘤直径平均(7.57±1.8)cm。9例手术均顺利完成,其中采取经腹腔途径6例,采取经腹膜后途径3例,所有病例无需转开放手术。手术平均时间(137±38)min,术中出血(54.5±120.6)m L,患者平均住院时间为(13.8±2.0)d。病理证实为肾上腺皮质腺瘤5例,嗜铬细胞瘤2例,肾上腺皮质癌2例。术前有高血压者血压均恢复正常,均未发现肿瘤复发或转移。结论腹腔镜巨大肾上腺肿瘤切除术虽手术时间长,术中出血多,但只要术者具备娴熟的腹腔镜操作技巧及充分的临床经验,腹腔镜较大肾上腺肿瘤切除术切实可行,肿瘤大小并不是决定手术方式的主要因素。
Objective To investigate the feasibility of laparoscopic resection of giant adrenal tumors and surgical techniques. Methods The clinical data of 9 patients with giant adrenal tumors treated by intra-abdominal or retroperitoneal laparoscopic resection from January 2010 to December 2016 in Erdos Central Hospital of Inner Mongolia were retrospectively analyzed. The operative skills were summarized. Results Eight of the eight patients had clinical symptoms and two asymptomatic tumors. Tumor diameter averaged (7.57 ± 1.8) cm. All of the 9 cases were successfully performed. Among them, 6 cases were treated by transperitoneal approach and 3 cases were treated by retroperitoneal approach. All the cases did not need to be transferred to open surgery. The mean operation time was (137 ± 38) min, intraoperative bleeding was (54.5 ± 120.6) m L, and the average hospital stay was (13.8 ± 2.0) days. Pathology confirmed adrenocortical adenoma in 5 cases, pheochromocytoma in 2 cases, adrenal cortex cancer in 2 cases. Preoperative blood pressure were normal, no tumor recurrence or metastasis were found. Conclusions Although laparoscopic giant adrenalectomy has a long operation time and many intraoperative bleeding, as long as the surgeon has adept laparoscopic operation skills and sufficient clinical experience, laparoscopic larger adrenalectomy is feasible and the tumor size is not The main factors that determine the surgical approach.