More than 90% of adrenal tumors are benign lesions and small in size. It has a complex anatomy due to the deep location and closely related to many important structures including liver, spleen, pancreas, inferior vena cava and renal vessels. Open adrenectomy requires 20–30 cm length skin incision to resect a 2–3 cm tumors. This is a complicated surgery with high risk of mortality when injury to major vessels and vital organs. Laparoscopic technology, has gained great popularity worldwide for its prominent minimally invasive advantages including less traumatic, quick recovery, minimal postoperative pain, shorter hospital stay and small scar. With the evidences from large number of clinical trials and multi-center comparative analysis, it has replaced the open surgery as the mainstream surgical approach in the era of minimally invasive surgery due to its safety and reliability.

Retroperitoneoscopic Anatomical Adrenalectomy

目的 介绍后腹腔镜解剖性肾上腺切除术的手术方法及临床效果.方法 2000年2月至2005年10月,对800例患者采取后腹腔镜解剖性肾上腺切除术.常规制备后腹腔操作空间.切开Gerota筋膜后,按顺序分别进入3个相对无血管解剖层面进行分离.第一分离层面位于肾脏内上方脂肪囊与前层Gerota筋膜之间,此层面可以在手术初期快速找到肾上腺;第二分离层面位于肾外上方脂肪囊与后层Gerota筋膜之间;第三分离层面位于肾上腺下方与肾上极之间.最后处理肾上腺中央静脉.依术前诊断和术中情况选择行肾上腺全切或次全切术.结果 除1例嗜铬细胞瘤(肿瘤直径7.8 cm)患者因肾上腺肿瘤与肝脏及下腔静脉粘连紧密行中转开放手术外,全部手术均成功完成.平均手术时间(45±19)min,平均术中出血量(25±11)ml.恢复饮食和下床活动时间分别为1.2 d和1.0 d.12例(1.5%)出现术后皮下气肿、皮下血肿或切口感染.除6例特发性肾上腺增生患者术后1年高血压复发外,其余患者临床症状均消失或明显好转.结论 后腹腔镜解剖性肾上腺切除术解剖层次清楚,术野清晰,疗效确切,为肾上腺外科疾病的治疗提供了更加安全的选择。

Technique of anatomical retroperitoneoscopic adrenalectomy

目的 探讨后腹腔镜下手术治疗肾上腺嗜铬细胞瘤的有效性和安全性.方法 行后腹腔镜肾上腺嗜铬细胞瘤切除术56例.肿瘤位于左侧24例、右侧30例、双侧2例.肿瘤直径1.5～10.0 cm,平均(4.5±2.0)cm.主要临床表现为高血压者45例;无高血压者5例,主诉心悸、恶心、呕吐、腹痛、消瘦等;无症状经体检发现者6例.56例均行内分泌常规检查和影像学检查.术前常规行扩容、降压及对症处理,术中术后严密监测血压变化并给予相应处理.结果 55例手术成功,1例中转开放手术.手术时间(52±22)min,术中估计出血量(74±34)ml,术后住院时间(5±1)d.术中术后未发生重大并发症.术中血压波动≥20 mm Hg(1 mm Hg=0.133 kPa)21例.病理报告均为嗜铬细胞瘤.随访5～36个月,36例患者术后2个月内血压恢复正常,9例仍需口服降压药物.肿瘤局部无复发.结论 后腹腔镜下肾上腺嗜铬细胞瘤手术具有微创、出血少、恢复快等优点,充分的术前准备、正确的术中操作是手术安全的保证。

Retroperitoneoscopic adrenalectomy for pheochromocytoma (report of 56 cases)

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Technique of anatomical retroperitoneoscopic adrenalectomy

Retroperitoneoscopic adrenalectomy for pheochromocytoma (report of 56 cases)