后腹腔镜八步法行巨大肾上腺肿瘤解剖性切除术  

Anatomical retroperitoneoscopic adrenalectomy for large adrenal tumor by eight-step procedure

作　　者：王凯[1] 邢念增[1] 张军晖[1] 田溪泉[1] 王建文[1] 牛亦农[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《临床泌尿外科杂志》2014年第6期492-494,498,共4页Journal of Clinical Urology

基　　金：北京市卫生系统高层次卫生技术人才(学科骨干)项目(编号2011-3-014)

摘　　要：目的：介绍采用后腹腔镜八步法行巨大（直径≥5cm）肾上腺肿瘤解剖性切除术的手术技巧及临床效果。方法：2009年1月～2013年10月期间对34例巨大肾上腺肿瘤患者采用后腹腔镜八步法行巨大。肾上腺肿瘤解剖性切除术：①清除腹膜外脂肪；②打开Gerota筋膜，游离肾脏背侧间隙；③游离肾脏腹侧间隙；④打断肾脏与肿瘤之间的连接；⑤游离肾上腺肿瘤膈面；⑥游离肾上腺肿瘤腹侧；⑦处理肾上腺肿瘤上极；③完整切除肿瘤。结果：34例腹腔镜手术全部完成，仅1例中转开放手术。肿瘤平均直径[7．3±2．4（5．5～14．5）]cm，平均手术时间[89±44（30～185）]min，术中平均估计出血量[172±246（10～1000）]ml。1例术中输血800ml，1例术后输血400ml；1例术后并发急性肺水肿，保守治疗后康复；术后平均恢复饮食时间为[1．6±0．9（1～4）3d，术后平均住院时间为[6．3±2．6（3～14）3d。结论：按照八步法行后腹腔镜巨大肾上腺肿瘤解剖性切除术，具有操作空间充分、层次清楚、视野清晰、手术成功率高、创伤小、出血少及并发症少等优点。后腹腔镜八步法巨大。肾上腺肿瘤解剖性切除术安全可行。Objective：To introduce the surgical technique and clinical efficacy of anatomical retroperitoneoscop- ic adrenalectomy for large adrenal tumor （≥5 cm） by eight-step procedure. Method：We retrospectively analyzed the clinical data of 34 cases performed retroperitoneal anatomical laparoscopic adrenalectomy from January 2009 to October 2013. We performed eight-step laparoscopic adrenaleetomy for large adrenal tumor retroperitoneally. The procedure was as follows：①clear extraperitoneal fat tissue; ②open Gerota fascia and dissect dorsal space behind the kidney; ③dissect between the kidney and peritoneal membrane; ④interrupt the connection between the kidney and adrenal tumor; ⑤dissect the adrenal tumor along the diaphragm surface; ⑥free the peritoneal side of adrenal tumor; ⑦dissect the upper pole of adrenal tumor; ⑧remove the tumor. Result： All operations succeeded except that one case converted to open surgery. The mean diameter of tumor was [7.3±2.4 （range, 5.5-14.5）]cm. The mean operative time and estimated blood loss was [89±44 （range, 30-185）]minutes and [172±246 （range, 10-1 000）]ml, respectively. Two patients needed blood transfusion, 800 ml for one case during the operation and 400 ml for another patient after the operation. Only one patient was found acute pulmonary edema postoperatively, and recovered after Conservative treatment. The average postoperative interval to oral intake and postoperative hospital stay was [1.6±0.9 （range, 1-4）]days and [6.3±2.6 （range, 3-14）]days, respectively. Conclusion：According to eight-step procedure retroperitoneally, anatomical laparoscopic adrenalectomy for large adrenal tumor （~5 cm ） has advantages of minimal invasion, such as sufficient operation space, clear anatomical layers, less blood loss and fewer complications. The eight-step retroperitoneoscopic anatomical adrenalectomy for large adrenal tumor is safe and feasible.

关 键 词：肾上腺肿瘤 腹腔镜术 肾上腺切除术 

分 类 号：R736.6[医药卫生—肿瘤]