巨大左侧肾上腺肿瘤切除技巧及脾胰损伤原因分析  

Surgical techniques of resection for giant left adrenal tumor and experience of avoiding intraoperative splenic and pancreatic injury

作　　者：张涛[1] 于德新[1] 谢栋栋[1] 王毅[1] 丁德茂[1] 陈磊[1] 闵捷[1] 邹慈[1] 张志强[1] 

机构地区：[1]安徽医科大学第二附属医院泌尿外科,合肥230601

出　　处：《临床泌尿外科杂志》2012年第12期913-915,共3页Journal of Clinical Urology

摘　　要：目的:探讨巨大左侧肾上腺肿瘤切除的手术技巧,并分析术中损伤脾脏、胰腺的可能原因。方法:回顾性分析我院于2009年2月～2012年7月间收治的7例巨大左侧肾上腺肿瘤患者的临床资料。结果:行经腹左侧肋缘下切口4例,腹部Chevron切口3例。肿瘤直径10～23cm,平均16.7cm。手术时间平均323.8min(150～404min);术中估计失血量平均1 140ml(400～2 600ml),术中输血量平均680ml(0～1 600ml)。术后病理报告提示恶性嗜铬细胞瘤2例,嗜铬细胞瘤2例,肾上腺皮质腺癌1例,肾上腺皮质腺瘤1例,成熟性畸胎瘤1例。围手术期无患者死亡。术中出现脾脏损伤1例,胰腺损伤1例。术后无急性胰腺炎、急性肾功能衰竭、深静脉血栓形成等严重并发症发生。结论:经腹肋缘下切口和腹部Chevron切口对于切除巨大左侧肾上腺肿瘤可获得良好暴露。脾胰整体翻转可直视下切除肿瘤,有利于缩短手术时间,并减少术中术后并发症。Objective：To investigate the surgical techniques of resection for giant left adrenal tumor, and ana- lyze the possible causes of splenic injury and pancreatic injury in the procedure. Method：The clinical data of 7 pa- tients with giant left adrenal tumor exceeding 10 cm in diameter which were treated in our center between February 2009 to July 2012 were reviewed retrospectively. Result： In 4 patients, the tumors were removed by left subcostal incision and 3 by chevron incision. The average （range） diameter of the tumor was 16.7cm（10-23 cm）. The mean （range） operative duration was 323.8min（150-404 rain）, the mean （range） estimated intraoperative blood loss was 1 140 m1（400-2 600 ml）. and the mean （range） transfusions during surgery was 680 ml（0-1 600 ml）. Pathological diagnosis included malignanl pheochromocytoma in 21 pheochromocytoma in 2, adrenal cortical adenocarcinoma in 1, adrenocortical adenoma in 1, and teratoma in 1. There was no intraoperative or perioperative deaths. However, there were intraoperative splenic injury in 1 case, and pancreatic injury in 1 case. No patients had acute pancreati- tis or acute renal failure. Deep venous thrombosis and other serious complications were also not seen. Conclusion： Transabdominal subcostal incision and chevron incision can provides excellent exposure of the structures in the left upper abdomen. Subsequently, when the spleen and pancreas are mobilized, we can grasp the tumor in direct. Thus, safe resection of the tumor is possible, as well as shorten the operation time and reduce perioperative com- plications.

关 键 词：肾上腺肿瘤 脾胰整体翻转术 外科手术 脾损伤 胰腺损伤 

分 类 号：R736.6[医药卫生—肿瘤]