摘要
目的：总结腹腔镜肾上腺切除术治疗直径≥6cm肾上腺肿瘤的经验。方法：回顾分析2004年2月至2006年10月34例患者接受腹腔镜肾上腺切除术的，临床资料。其中肿瘤直径≥6cm 11例，〈6cm23例。随访17～49个月。结果：与小体积（直径〈6cm）肾上腺肿瘤切除术相比，大体积（直径≥6cm）肿瘤患者的手术时间较长（268min vs．172min；P=0．004），术中出血较多（571ml vs．83ml；P=0．003），术后住院天数较长（10．6d vs ．6．9d；P=0．007），中转开放手术率也较高，但差异无统计学意义（18．2％vs ．0；P=0．098），手术并发症发生率两者无差异（27．3％VS．17．4％；P=0．656）。随访期间，无一例肿瘤局部复发，1例患者因肿瘤肺转移死亡。结论：对有经验的外科医师而言腹腔镜下完整切除大体积（直径≥6cm）肾上腺肿瘤技术上是可行的，不增加手术并发症发生率和肿瘤局部复发率。术前通过CT判断肿瘤有无周围组织侵润是手术取得成功的关键。
Objective： Laparoscopic adrenalectomy has become a standard approach for the resection of adrenal tumors, but it is difficult to use this approach in patients with large adrenal tumors. In this article, we describe and summarize the clinical experience with laparoseopic adrenalectomy to adrenal tumors ≥6cm in size. Methods ：The clinical data of 34 cases who had a laparoscopic adrenalectomy between Feb. 2004 and Oct. 2006 were reviewed retrospectively. Among them, 11 cases had adrenal tumors measued ≥ 6cm in diameter and 23 patients had tumors measued 〈 6cm in diameter. The follow-up for all cases ranged from 17 to 49 months. Results： Compared with patients with tumors 〈 6cm, patients with large tumors （≥ 6cm） had longer operating time （268min vs. 172min ; P = 0. 004）, greater operative blood loss （ 571ml vs. 83ml; P = 0. 003 ） and longer postoperative hospitalization （ 10.6d vs. 6.9d; P = 0.007 ）. The cases in large tumor group had an increased conversion rate even if the difference was not significantly statistical （ 18.2% vs. 0;P = 0.098 ）. The overall morbidity rates of two groups were similar（27.3% vs. 17.4% ;P = 0.656）. During follow-up of all cases, there were no local recurrences and one case died for lung metastasis. Condusions：Laparoscopic adrenalectomy for large adrenal tumor （≥6cm） is technically feasible for experienced surgeons. It can achieve an en bloc excision of the adrenal gland without increasing local recurrence and morbidity rate. The preoperative CT finding a well-encapsulated adrenal tumor with no evidence of invasion into surrounding tissue is very important for accomplishment of this operation.
出处
《腹腔镜外科杂志》
2008年第5期373-375,共3页
Journal of Laparoscopic Surgery
