“重心牵引法”腹腔镜肾上腺及腺瘤切除术

摘要

目的：：探讨腹腔入路腹腔镜肾上腺(腺瘤)切除术(TLA)的手术方法和操作技巧.方法：对2011年1月~2013年12月收治的312例肾上腺腺瘤采用TLA治疗,肿瘤位于左侧160例,右侧152例,瘤体直径0.5~3.8 cm,平均(2.2±0.8)cm.经腹腔入路手术,分离出肾上腺最低位并上牵引导其重心移动,靠近腺体和肿瘤边缘快速切割、移除病变.结果：312例手术均成功,无中转开放.手术时间8~19 min,平均(12±3)min；术中失血量5~100 ml,平均(20±6)ml.膈肌损伤1例,右肾静脉破口1例,肝挫裂伤1例,左肾包膜裂伤1例,无迟发性大出血.切口感染2例,肾上腺皮质危象2例,均经相应治疗后痊愈.术后住院时间3~7 d,平均(6±3)d.临床病理诊断为醛同酮腺瘤123例,库欣腺瘤106例,无功能腺瘤83例.结论：腹腔入路“重心牵引法”TLA 操作步骤明确,解剖层次清晰,手术快速,疗效确切,是肾上腺腺瘤外科治疗的一种安全选择.%Objective:To investigate the surgical method and operational skills of transperitoneal laparoscopic adrenalectomy (TLA)in the treatment of adrenal adenoma.Methods:From Jan.2011 to Dec.2013,in total 312 ca-ses of adrenal adenoma were treated by TLA.Adrenal tumors located at left in 160 and right in 152 cases with an av-erage diameter was (2.2±0.8)cm.The lowest location of adrenal gland was dissected and drawed upward firstly, then accompanied by the moving of"barycenter site",soon quickly cutting technique was used near to the borderline of adrenal gland and adenoma.Results:All of the 3 1 2 cases were successfully operated by TLA,no converted to open.The average operating time was (12±3)min,the mean blood loss was (20±6)mL.1 case suffered diaphragm inj ury,1 had a right renal vein crevasse,1 suffered liver bruise and 1 had a lacerating wound of kidney capsule,no tardive hemorrhoea.2 cases of incision infection and 2 cases of Addisonian crisis occurred and healed.Postoperative hospital stay was 3 to 7 days with an average of (6±3)d.The definitive diagnosis include 123 cases of primary hy-peraldosteronism adenoma,106 cases of Cushing's adenoma and 83 cases of non-functioning adrenal adenoma.Con-clusions:TLA of"barycenter tractive method"is one of the favorable approaches for the treatment of adrenal adeno-ma,the procedure is with precise surgical step and well-defined anatomic landmarks,so the operation could be com-pleted quickly and followed with reliable curative effects.