摘要:
Objective To explore the surgical features of retroperitoneoscopic excision of adrenal myelolipoma with diameter larger than 6 cm. Methods We retrospectively analyzed clinical data of 28 cases of giant adrenal myelolipoma from March 2010 to December 2015.The diameter of tumor was 6.0-13.7 cm (mean, 8.5 cm).There were 10 left-sided cases and 18 right-sided cases. During the retroperitoneoscopic excision of adrenal myelolipoma , four trocars were used .Two silk sutures were twisted as a loop to entangle one side of the tumor and then pulled it .Blood vessel on the surface of tumor was sealed and cut by ultrasonic scalpel . Adrenal gland was totally or partially removed and the tumor was resected completely . Results The operations were successful in all the 28 cases without hemorrhage during or after the surgery , conversion to open surgery , or injury of adjacent organs .The operation time was 52-117 min (mean, 67.5 min) and the blood loss was 45-110 ml during operation (mean, 60.5 ml).Patients took food 1-2 days after operation and ambulated 3-5 days after operation .The indwelling time of retroperitoneal drainage tube was 3-6 d (mean, 4.1 d).The postoperative hospitalization time was 6 -9 d (mean, 7.5 d). Conclusions Giant myelolipoma leads to seriously changed normal anatomy and is hard to be exposed during operation .Only when the important anatomical landmarks , large blood vessels and adrenal glands are focused , can the operation be safe and controllable .%目的 探讨后腹腔镜治疗巨大(直径>6 cm)肾上腺髓样脂肪瘤的手术要点.方法 回顾性分析2010年3月~2015年12月28例巨大肾上腺髓样脂肪瘤的临床资料,肿瘤直径6.0~13.7 cm,平均8.5 cm,右侧18例,左侧10例.行后腹腔镜下髓样脂肪瘤切除术,常规置4个工作通道,用双10号丝线扭曲成环套住肿瘤一端起牵引作用,用超声刀切断瘤体表面血管,肾上腺全切或次全切除,完整切除肿瘤.结果 28例均获成功,无中转开放手术,无术中、术后大出血及肿瘤毗邻脏器副损伤.手术时间52~117 min,平均67.5 min,术中出血45~110 ml,平均60.5 ml,术后1~2 d排气后进食,3~5 d下床活动,腹膜后引流管留置时间3~6 d,平均4.1 d,术后住院时间6~9 d,平均7.5 d.结论 巨大肾上腺髓样脂肪瘤肿瘤体积巨大,使正常的解剖结构遭到严重破坏,术中暴露困难,手术难度增加,术中要注意重要解剖标志,及血管和肾上腺的处理,手术才安全可靠.