经腹膜后途径二次肾上腺区腹腔镜手术体会  

Experience of retroperitoneal laparoscopic re-operation in the adrenal region

作　　者：周峰[1] 汪超军[1] 蒋鹏[1] 杨凯[1] 金百冶[1] 蔡松良[1] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003

出　　处：《微创泌尿外科杂志》2014年第3期135-137,共3页Journal of Minimally Invasive Urology

基　　金：浙江省教育厅课题资助(Y201018597)

摘　　要：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68d.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.To-investigate-the-feasi-bility-of-re-operati-on-by-retroperitoneal-laparoscopy-inadrenal-re-gi-on-.Methods-:Four-patients-who-under-went-retroperitoneal-laparoscopy-for-a-second-operati-on-fro-m-January-201-1-to-January-201-4-inour-hospital-were-anal-yzed-retrospecti-vel-y-.All-the-patients-had-recei-ved-an-i-psilateral-operati-on-by-laparoscopic-orretroperitoneal-laparoscopic-approaches-.Among-the-patients-,one-was-diagnosed-as-havi-ng-recurrent-pheochro-mocyto-ma-,t-wo-as-havi-ng-APA,and-one-as-havi-ng-UNAH-.The-i-nterval-bet-ween-the-t-wo-operati-ons-ranged-fro-m-0??5-to-4??3-years-with-a-mean-of-2??5-years-.Retroperitoneal-laparoscopic-approach-was-e-mpl-oyed-inall-the-pa-tients-for-the-second-operati-on-.Through-an-i-ncisi-on-at-the-mi-daxillary-li-ne-2-c-m-above-the-crista-iliaca-,we-i-ntroduced-the-first-trocar-i-nto-the-abdo-mi-nal-cavity-and-established-pneu-moperitoneu-m.The-lesi-ons-were-fi-nall-y-re-moved-by-an-ato-micall-y-separati-ng-the-tissues-layer-by-layer-.Results-:The-procedure-was-co-mpleted-inall-the-patients-within75-1-83-min(mean-1-01-min).The-i-ntraoperati-ve-bl-ood-l-oss-was-1-36-mL-averagel-y-(rangi-ng-fro-m-50-to-300-mL-).The-patients-were-discharged-fro-m-hospital-in4-to-1-0-days-(mean-6??8-days-)after-thesecond-surgery-,and-all-of-the-m-re-cei-ved-a-foll-o-w--up-for-4-to-42-months-and-no-maj-or-co-mplicati-on-occurred-.Conclusions-:Re-operati-on-by-retroperito-neal-laparoscopy-inthe-adrenal-regi-on-is-feasi-ble-inproperl-y-selected-cases-with-skilled-and-experienced-hands-.

关 键 词：后腹腔 腹腔镜 肾上腺区 二次手术 

分 类 号：R699[医药卫生—泌尿科学]