“liftoff”模块化方法在机器人辅助腹腔镜手术治疗复杂肾上腺肿瘤中的临床应用(附手术视频)  

Application value of the"liftoff"modular method in robot-assisted laparoscopic surgery for complex adrenal tumors

作　　者：曾圣涛 杨成林 王尉 叶嘉涛 胡正飞 张小明 张惠芬 刘天培 Zeng Shengtao;Yang Chenglin;Wang Wei;Ye Jiatao;Hu Zhengfei;Zhang Xiaoming;Zhang Huifen;Liu Tianpei(First School of Clinical Medicine,Southern Medical University,Department of Urology,the General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]南方医科大学第一临床医学院南部战区总医院泌尿外科,广州510010

出　　处：《中华泌尿外科杂志》2024年第4期282-286,共5页Chinese Journal of Urology

基　　金：广州市科技计划项目(2024A03J0641);广东省基础与应用基础研究基金(2020A1515010044)。

摘　　要：目的探讨“liftoff(起飞)”模块化方法在机器人辅助腹腔镜手术治疗复杂肾上腺肿瘤中的应用价值。方法回顾性分析2022年5月至2023年6月南部战区总医院收治的15例复杂肾上腺肿瘤患者的临床资料,男5例,女10例。年龄(47.6±7.8)岁。伴糖尿病2例,高血压病6例,冠心病1例。体质量指数26.5(23.8,27.9)kg/m^(2),其中≥28kg/m^(2)3例。术前内分泌激素检查示血儿茶酚胺异常5例,血皮质醇异常2例。B超、CT检查提示肿瘤位于左侧9例,右侧6例;肿瘤直径(7.61±2.77)cm,其中≥6cm10例;肿瘤压迫邻近大血管或脏器4例,所有患者均接受经腹腔途径机器人辅助腹腔镜肾上腺肿瘤切除术。全麻,患者取健侧卧位。术中使用“liftoff”模块化方法,即将肾上腺分为外侧、内侧、背侧、头侧和肾上腺-肾平面侧,根据左、右侧肾上腺肿瘤的差异,采用不同的模块化游离步骤:左肾上腺按内侧和背侧、肾上腺-肾平面侧、外侧和头侧为主线的顺序游离;右肾上腺按外侧和背侧、肾上腺-肾平面侧、内侧和头侧为主线的顺序游离。游离时适当牵拉肿瘤,使之呈“liftof”状。记录患者围手术期相关指标和随访情况。结果本研究15例手术均顺利完成,无中转开放手术。手术时间118(102,130)min。术中出血量102(69,163)ml。术后引流管留置时间4(3,5)d。术后住院时间6(4,7)d。术后病理诊断:嗜铬细胞瘤5例,大结节性增生3例,单纯皮质腺瘤6例,髓性脂肪瘤1例。术后随访6~12个月,15例均恢复良好,未见肿瘤复发。结论机器人辅助腹腔镜手术中采用“liftoff”模块化方法处理复杂肾上腺肿瘤安全、可行,有助于高效切除肿瘤。Objective This study aims to explore the application value of the"liftoff"modular method in robot-assisted laparoscopic surgery for complex adrenal tumors.Methods We retrospectively analyzed the clinical data of 15 patients with complex adrenal tumors treated at the General Hospital of Southern Theater Command from May 2022 to June 2023.The cohort comprised 5 males and 10 females with an average age of(47.6±7.8)years and a body mass index(BMI)of 26.5(23.8-27.9)kg/m^(2).Among the patients,3 had a BMI≥28 kg/m^(2),2 had diabetes,6 had hypertension,and 1 had coronary heart disease.Preoperative endocrine hormone examination revealed abnormal blood catecholamines in 5 cases and abnormal blood cortisol in 2 cases.Ultrasound and CT scans indicated that 9 tumors were located on the left side and 6 on the right,with 4 cases showing tumor compression on adjacent large blood vessels or organs.The average tumor diameter was(7.61±2.79)cm,with 10 cases having a diameter≥6 cm.All patients underwent laparoscopic adrenalectomy assisted by robots through the transperitoneal approach.The surgeries were performed in a lateral position under general anesthesia.The"liftoff"modular method was utilized to separate the treatment of adrenal tumors into lateral,medial,dorsal,cephalic,and adrenal renal plane sides.Tumors were appropriately manipulated during the operations to achieve a"liftoff"shape.Different modular dissociation steps were adopted based on the size and location of the left and right adrenal tumors.The left adrenal gland was dissected in the order of medial and dorsal,adrenal renal plane side,and lateral and cephalic sides,while the right adrenal gland was dissected in the order of lateral and dorsal,adrenal renal plane side,and medial and cephalic sides.Postoperative related indicators and follow-up status of patients were recorded and analyzed.Results All 15 surgeries were successfully completed without any conversions to open adrenalectomy,with an average operation time of 118(102-130)minutes and an average intraope

关 键 词：机器人手术 肾上腺肿瘤 模块化 腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]