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目的:探讨后腹腔镜切除大肾上腺肿瘤(最大直径大于6cm)的可行性。方法:回顾性分析2002年6月~2013年6月上海长征医院泌尿外科98例行后腹腔镜下大肾上腺肿瘤切除患者的临床资料。98例均采用健侧卧位,用自制的气囊扩张后腹腔,分别在腋后线肋缘下、腋中线髂嵴上2cm及腋前线肋缘下穿刺,置入Trocar。用标本袋取出切除后肿瘤,留置引流管。结果:肿瘤最大直径6.5~12.6cm,平均(8.1±3.2)cm,96例手术成功,早期2例中转开放,手术时间45~135min,平均65min,术中出血50~700ml,平均80ml,术后随访3~36个月,平均18.5个月,无局部复发及远处转移者87例,死亡9例,其中肿瘤相关死亡例数7例。结论:对于无明显禁忌证的患者,后腹腔镜手术切除大肾上腺肿瘤(>8cm)是可行的和安全的,肿瘤直径并不是手术的决定性因素。
Objective: To investigate the feasibility of retroperitoneoscopic resection of large adrenal tumors (maximum diameter greater than 6cm). Methods: The clinical data of 98 patients undergoing laparoscopic radical adrenalectomy for 98 cases of urology from Shanghai Changzheng Hospital from June 2002 to June 2013 were retrospectively analyzed. 98 cases were used contralateral lateral position, with homemade balloon dilatation abdominal cavity, respectively, in the axillary line costa marginate, axillary midline axillary crest 2cm and axillary margin puncture, into the Trocar. Remove the excised tumor with a specimen bag and place the drainage tube. Results: The maximum diameter of tumor was 6.5 ~ 12.6 cm (mean, 8.1 ± 3.2 cm). The operation was successful in 96 cases. The early 2 cases were switched to open operation. The operation time ranged from 45 to 135 minutes (average 65 minutes) All the patients were followed up for 3 to 36 months with an average of 18.5 months. There were 87 cases without local recurrence and distant metastasis and 9 cases died with tumor-related deaths in 7 cases. CONCLUSIONS: Retroperitoneal laparoscopic resection of large adrenal tumors (> 8 cm) is feasible and safe for patients with no obvious contraindications, and tumor size is not a decisive factor in surgery.