[1]马然①,邱敏,马潞林,等.后腹腔镜手术治疗巨大（≥6 cm）肾上腺肿瘤的临床分析[J].中国微创外科杂志,2017,17(1):55-58.
　Ma Ran,Qiu Min*,Ma Lulin*,et al.Clinical Analysis of Retroperitoneal Laparoscopic Adrenalectomy for Large (≥6 cm) Adrenal Tumors[J].Chinese Journal of Minimally Invasive Surgery,2017,17(1):55-58.
点击复制

后腹腔镜手术治疗巨大（≥6 cm）肾上腺肿瘤的临床分析 ()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年1期
页码:
55-58
栏目:
临床研究
出版日期:
2017-04-18

文章信息/Info

Title:
Clinical Analysis of Retroperitoneal Laparoscopic Adrenalectomy for Large (≥6 cm) Adrenal Tumors
作者:
马然①; 邱敏; 马潞林; 刘余庆**; 卢剑**
北京大学第三医院泌尿外科，北京100083
Author(s):
Ma Ran;  Qiu Min*;  Ma Lulin*;  et al.
*Department of Urology, Peking University Third Hospital, Beijing 100083, China
关键词:
肾上腺切除术; 巨大肾上腺肿瘤; 后腹腔镜手术
Keywords:
Adrenalectomy; Large adrenal tumor; Retroperitoneal laparoscopy
文献标志码:
A
摘要:
目的探讨后腹腔镜手术治疗直径≥6 cm肾上腺肿瘤的安全性及效果。方法回顾性分析2006年5月~2015年10月经后腹腔途径行肾上腺肿物切除73例的临床资料，男33例，女40例，年龄13~79岁，（46.6±16.0）岁，左侧32例，右侧41例，肿物最大径线6~15.2 cm，（8.2±2.0）cm。结果完成后腹腔镜手术70例，手术时间（159.4±64.0）min；中转开放手术3例。术中出血≤100 ml 55例，100~400 ml 11例，>400 ml 7例，输血7例。术中并发症7例，均发生在肿瘤直径>9 cm的病例中，包括膈肌损伤2例（其中1例合并腔静脉损伤大出血），腔静脉损伤出血1例，腹膜损伤4例。术后住院时间（7.5±1.2）d。术后病理肾上腺髓脂肪瘤18例，嗜铬细胞瘤16例，节细胞神经瘤9例，肾上腺皮质腺瘤5例，其他良性病变19例；肾上腺转移癌3例，恶性嗜铬细胞瘤2例，肾上腺皮质癌1例。随访3~36个月，失访14例，转移癌扩散1例，肾积水2例。 结论对于有一定经验的术者，后腹腔镜手术治疗直径≥6 cm肾上腺肿瘤安全有效，其中直径>9 cm肾上腺肿瘤的手术并发症发生率较高。
Abstract:
ObjectiveTo evaluate the safety and efficacy of retroperitoneal laparoscopic adrenalectomy for adrenal tumors with diameter greater than or equal to 6 cm.MethodsClinical data of 73 cases who received retroperitoneal laparoscopic adrenalectomy from May 2006 to October 2015 were reviewed retrospectively, including 33 male and 40 female. The mean age was 466±16.0 (range, 13-79) years old. There were 32 left-sided cases and 41 right-sided cases. The mean tumor diameter size was 8.2±2.0 cm (range, 6-15.2 cm).ResultsThe operations were successfully conducted in 70 cases, with a mean operation time of (159.4±64.0) min. Conversion to open surgery was required in 3 cases. The bleeding during operation was ≤ 100 ml in 55 cases, 100-400 ml in 11 cases, and > 400 ml in 7 cases. The blood transfusion was needed in 7 cases. Complications occurred in 7 cases, all of which were large tumor cases (diameter > 9 cm), including 2 cases of diaphragmatic injury (combined with hemorrhage in 1 case), 1 case of simple vena cava rupture hemorrhage, and 4 cases of peritoneal damage. The mean hospital stay after operation was 7.5±1.2 d. Postoperative pathological outcomes included 18 cases of adrenal myelolipoma, 16 cases of pheochromocytoma, 9 cases of ganglioneuroma, 5 cases of adrenal cortical adenoma, 19 cases of other benign lesions, 3 cases of adrenal metastasis, 2 cases of malignant pheochromocytoma, and 1 case of adrenal cortical carcinoma. During the follow-up for 3-36 months, there were 14 cases of missed follow-up, 1 case of recurrence, and 2 cases of hydronephrosis.ConclusionsRetroperitoneal laparoscopic adrenalectomy in the treatment of large adrenal tumors with diameter greater than or equal to 6 cm is safe and effective in experienced surgeons. The complication rate will be high in cases with tumor diameter lager than 9 cm.

参考文献/References:

[1]Wein AJ.Campbell-Walsh Urology.10th ed.New York:Saunders Elsevier,2012.1751.
[2]那彦群.中国泌尿外科疾病诊断治疗指南（2014版）.北京:人民卫生出版社，2013.527-528.
[3]Tiberio GA,Solaini L,Arru L,et al.Factors influencing outcomes in laparoscopic adrenal surgery.Langenbecks Arch Surg,2013,398(5):735-743.
[4]Constantinides VA,Christakis I,Touska P,et al.Retroperitoneoscopic or laparoscopic adrenalectomy?A single-centre UK experience.Surg Endosc,2013，27(11):4147-4152.
[5]Cabalag MS,Mann GB,Gorelik A,et al.Comparison of outcomes after laparoscopic versus posterior retroperitoneoscopic adrenalectomy:a pilot study.Surg Laparosc Endosc Percutan Tech,2014，24(1):62-66.
[6]Kiriakopoulos A,Economopoulos KP,Poulios E,et al.Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center:a paradigm shift.Surg Endosc,2011，25(11):3584-3589.
[7]唐正严，黄亮，王桂林，等.解剖性后腹腔镜巨大肾上腺肿瘤切除术的临床经验及探讨.中国内镜杂志,2015,21(2):186-189.
[8]Brix D,Allolio B,Fenske W,et al.German Adrenocortical Carcinoma Registry Group.Laparoscopic versus open adrenalectomy for adrenocortical carcinoma:surgical and oncologic outcome in 152 patients.Eur Urol,2010,58:609-615.
[9]Agha A,Iesalnieks I,Hornung M,et al.Laparoscopic trans- and retroperitoneal adrenal surgery for large tumors.J Minim Access Surg,2014,10(2):57-61.
[10]王浩,徐丹枫,刘玉杉,等.后腹腔镜手术切除巨大肾上腺肿瘤.中国微创外科杂志,2009,9(10):905-907.
[11]黄建生,房杰群,方烈奎,等.腹腔镜手术切除巨大肾上腺肿瘤（附15例报告）.临床泌尿外科杂志,2014,29(1):10-13.
[12]Piotr M,Magda M,Jerzy ,et al.Videoscopic adrenalectomy:when does retroperitoneal seem better? Wideochir Inne Tech Maloinwazyjne,2014,9(2):226-233.
[13]张大宏,刘锋,毛祖杰.巨大肾上腺肿瘤腹腔镜手术.现代泌尿外科杂志,2014,19(10):633-635.
[14]傅点,王玲,徐锋,等.后腹腔镜下切除巨大肾上腺肿瘤的临床观察.临床肿瘤学杂志,2014,19(6):547-549.
[15]Wang W,Li P,Wang Y,et al.Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma:a prospective,nonrandomized,controlled study.Am J Surg,2015,210(2):230-235.
[16]Agrusa A,Romano G,Frazzetta G,et al.Laparoscopic adrenalectomy for large adrenal masses:single team experience.Int J Surg,2014,12 Suppl 1:S72-S74.
[17]Wang B,Ma X,Li H,et al.Anatomic retroperitoneoscopic adrenalectomy for selected adrenal tumors >5 cm:our technique and experience.Urology,2011,78(2):348-352.
[18]Bozkurt IH,Arslan M,Yonguc T,et al.Laparoscopic adrenalectomy for large adrenal masses:is it really more complicated?Kaohsiung J Med Sci,2015,31(12):644-648.

备注/Memo

备注/Memo:
基金项目：吴阶平基金(2014A6144606）**通讯作者，E-mail：pku3uro@aliyun.com①（北京市昌平区医院泌尿外科，北京102200）
更新日期/Last Update: 2017-04-18