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目的:探讨腹腔镜下肾上腺巨大肿瘤(直径≥6 cm)切除术的技术方法和应用价值。方法:7例肾上腺肿瘤患者均行腹腔镜下肾上腺肿瘤切除术,在瘤体表面相对无血管区处切开包膜,沿包膜与瘤体之间迅速分离,切除肿瘤,填塞纱布止血。结果:5例腹腔镜下肾上腺肿瘤切除术顺利完成,1例手助腹腔镜下完成,1例粘连明显转开放手术。平均手术时间120 min;平均术中出血量200 ml。术后1～4天肠功能恢复,3～5天拔除引流管;无明显外科并发症,术后住院平均10天。术后病理诊断嗜铬细胞瘤4例,肾上腺囊肿1例,神经节细胞瘤1例,畸胎瘤1例。术后随访6(3～18)个月,临床症状消失,复查彩超及SCT未见肿瘤复发及恶性变。结论:腹腔镜下肾上腺肿瘤切除术创伤小、恢复快、效果满意,是治疗巨大肾上腺肿瘤的一种理想术式。
Objective: To investigate the technique and application value of laparoscopic adrenal giant tumor (diameter≥6 cm) resection. Methods: Seven patients with adrenal tumors underwent laparoscopic adrenalectomy, and the capsule was incised at the relatively avascular zone on the surface of the tumor. The tumors were rapidly separated along the capsule and the tumor. The tumors were removed and gauze was stopped to stop the bleeding. Results: Laparoscopic adrenalectomy was successfully performed in 5 cases. One hand was assisted by laparoscopy and one case was visibly transferred to open surgery. The average operation time was 120 min. The mean intraoperative blood loss was 200 ml. Intestinal function recovered 1 to 4 days after operation, and the drainage tube was removed within 3 to 5 days. There was no obvious surgical complications. The average postoperative hospital stay was 10 days. Postoperative pathological diagnosis of pheochromocytoma in 4 cases, adrenal cysts in 1 case, ganglioneuroma in 1 case, teratoma in 1 case. After 6 months (3-18) months of follow-up, the clinical symptoms disappeared. There was no tumor recurrence and malignant transformation in ultrasound and SCT. Conclusions: Laparoscopic adrenal tumor resection has the advantages of less trauma, faster recovery and satisfactory results. It is an ideal surgical method for the treatment of giant adrenal tumors.