经腹腔途径机器人辅助腹腔镜下肾上腺手术的经验总结（附243例报告）  

Experience of 243 cases in transperitoneal robotic-assisted laparoscopic surgery for adrenal diseases

作　　者：张小华[1] 王先进[2] 高逢彬 沈逸凡 许天源[2] 钟山[1] 陈善闻[1] 何威[2] 谢欣[2] 王晓晶[2] 沈周俊[1] 丁强[1] 

机构地区：[1]复旦大学附属华山医院泌尿外科,上海200040 [2]上海交通大学医学院附属瑞金医院泌尿外科

出　　处：《中华泌尿外科杂志》2017年第4期277-280,共4页Chinese Journal of Urology

摘　　要：目的总结机器人辅助腹腔镜下肾上腺手术的临床经验和优势。方法回顾性分析2010年3月至2017年2月收治的243例行经腹腔途径机器人辅助腹腔镜下肾上腺手术患者的临床资料，男99例，女144例。年龄19～84岁，平均51．6岁。肿瘤位于左侧140例，右侧97例，双侧6例。肿瘤直径0．8～12．0cm，平均3．3em，其中35．0cm者41例。体重指数〈24kg／m。者224例，324kg／m^2者13例，其中328kg／m。者6例。结果本组243例除2例中转开放或普通腹腔镜手术外，其余241例手术均顺利完成。其中，行机器人辅助腹腔镜下肾上腺肿瘤切除术204例（包括肾上腺全切除术193例，次全切除术11例），行机器人辅助腹腔镜下嗜铬细胞瘤切除术37例。手术时间20～130min，平均35min。术中出血量20—1200ml，平均80ml，术中输血6例（均为巨大肾上腺肿瘤切除术）。术中出现并发症2例（中央静脉损伤1例，胰腺损伤1例）。术后住院3～20d，平均5do术后病理诊断：嗜铬细胞瘤37例（其中5例术后随访诊断为恶性），皮质腺瘤149例，皮质腺癌3例，转移性肿瘤5例（小细胞肺癌4例，胃肠道腺癌1例），髓样脂肪瘤9例，肾上腺囊肿3例，支气管源性囊肿2例，结节状增生25例，血管平滑肌脂肪瘤2例，成熟畸胎瘤1例，皮质增生伴色素沉着1例，弥漫性大B细胞淋巴瘤1例，脉管瘤1例，节细胞神经纤维瘤4例。结论机器人辅助腹腔镜下肾上腺手术安全、有效，机器人辅助腹腔镜手术在处理复杂性。肾上腺肿瘤如巨大肾上腺肿瘤、嗜铬细胞瘤、需保留正常肾上腺组织的双侧肾上腺病变、超重及肥胖患者中具有一定的优势。Objective To summarize our experience in robotic-assisted laparoscopic surgery for adrenal diseases Methods The clinical data of 243 patients with adrenal tumor treated by robotic-assisted laparoscopic surgery from March 2010 to February 2017 were retrospectively reviewed. There were 99 men and 144 women. The mean age was 51.6 years （range, 19 -84）. Tumors located at left adrenal in 140 cases , right in 97 cases, and both sides in 6 cases. The average diameter was 3.32 cm （ range, 0.8 - 12 cm）. However, there were 41 cases whose tumor diameter were greater than 5 cm. Results There were 2 cases of conversion during operation, 1 case converted to open surgery and the other to the traditional laparoscope surgery. The mean operative time was 35 min （range, 20 - 130 min）. Estimated blood loss was 80 ml （range,20 - 1 200 ml）. Blood transfusion was needed in 6 cases. The mean postoperative hospital stay was 5d （range, 3 -20 d）. The pathological diagnosis included 37 cases of pheochromocytoma, 149 cases of cortical adenoma, 3 cases of cortical carcinoma, 5 cases of metastatic tumor, 9 cases of adrenal myelolipoma, 3 cases of adrenal cyst, 2 cases of bronchogenic cyst, 25 cases of adrenal nodular hyperplasia, 2 cases of angiomyolipomas, 1 case of mature teratoma, 1 case of diffuse large B-Cell lymphoma, 1 case of angioma, and 4 cases of neurofibromatosis. Conclusions Robotic-assisted laparoscopic adrenalectomy was safe and effective. Robotic-assisted laparoscopic surgery has the advantages over laparoscopic surgery in treatment of complicated adrenal tumor, such as large adrenal tumors, pheochromocytoma, bilateral adrenal diseases, overweight and obese patients with adrenal diseases.

关 键 词：肾上腺肿瘤 机器人 腹腔镜 肾上腺手术 

分 类 号：R736.6[医药卫生—肿瘤]