后腹腔镜肾上腺占位性病变切除术130例

摘要

Background and purpose:Laparoscopic retroperitoneal adrenalectomy makes access to the adrenal glands easier and less invasive than open surgery. The aim of this study was to evaluate the clinical efifcacy of laparoscopic retroperitoneal adrenalectomy.Methods:A total of 130 patients who underwent retroperitoneal adrenalectomy for adrenal mass from Jan. 2007 to Dec. 2012 in Fudan University Shanghai Cancer Center were retrospectively assessed. Their clinicopathological factors, perioperative complications and short-term prognostic data were retrieved from the medical records.Results:One hundred and twenty-seven of 130 patients underwent retroperitoneal adrenalectomy successfully, and 3 patients were converted to open surgery due to severe bleeding. Among 130 patients, 63 were male and 67 were female, with the mean age 50.0 years. The pathological results of the 130 patients indicated adrenocortical adenoma in 68, pheochromocytoma in 15, medullary lipoma in 13, adrenal cysts in 10 , ganglioneuroma in 7, metastatic cancer in 5, adrenal hyperplasia in 4, schwannoma in 3, lymphangioma in 2, adrenal hematoma in 1, adrenal cortical carcinoma in 1, adrenal angiosarcoma in 1 and the deputy spleen in 1 (one patient suffering from both pheochromocytoma and ganglioneuroma). The maximum diameters were ranging from 0.5 to 9.0 cm, and mean diameter was 3.48 cm. The average blood loss in surgery was 62.73 mL. Mean length of stay in hospital was 7 d. GradeⅠ complications occurred in 5 patients, including 2 of fever, 1 of food allergy, 1 of drug allergy and 1 of hypokalemia.Conclusion: Retroperitoneal adrenalectomy should be considered as the procedure of choice for the resection of most adrenal tumors in skilled centers with the advantages of minimal invasion, increased safety and faster recovery.%背景与目的：较开放手术，腹腔镜肾上腺占位性病变切除术具有微创与视野清晰的优点。该研究拟探讨后腹腔镜肾上腺占位性病变切除的临床价值。方法：回顾性收集2007年1月—2012年12月在复旦大学附属肿瘤医院行后腹腔镜肾上腺占位性病变切除术的患者共130例，比较患者临床病理特征、并发症情况及短期预后。结果：在130例患者中，男性63例，女性67例，平均年龄50岁。病理类型：肾上腺皮质腺瘤68例，嗜铬细胞瘤15例，髓样脂肪瘤13例，囊肿10例，节细胞神经瘤7例，转移性癌5例，肾上腺皮质增生4例，神经鞘瘤3例，淋巴管瘤2例，肾上腺血肿1例，肾上腺皮质癌1例，肾上腺血管肉瘤1例，副脾脏1例(其中1例患者同时患有嗜铬细胞瘤和节细胞神经瘤)。肿瘤最大直径为0.5~9.0 cm，平均为3.48 cm，平均术中出血量为62.73 mL，平均术后住院时间为7 d。其中3例患者转为开放手术，另有5例患者发生术后并发症，其中发热2例，食物过敏1例，药物过敏1例，低血钾1例。结论：后腹腔镜肾上腺占位性病变切除术具有创伤小、安全性高，患者术后恢复快的优点，有利于在有条件的中心开展。