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目的总结直径≥10cm肾上腺肿瘤的腹腔镜手术的手术要点及临床经验。方法 2011年6月至2012年9月对5例直径≥10cm的肾上腺肿瘤实施了腹腔镜切除术,观察临床效果,并分析和总结手术入路、操作技巧。结果 5例腹腔镜下≥10cm肾上腺肿瘤切除术均顺利完成,均为经腹腔入路,无术中、术后并发症,手术时间130～270min,平均(180±65)min,术中出血50～300ml。术后2～3d排气,5～7d出院。病理结果:嗜铬细胞瘤1例,肾上腺皮质腺瘤1例,神经鞘瘤1例,髓质脂肪瘤2例。结论在技术娴熟的基础上,结合准确的手术入路、舒适的穿刺套管位点、充分的手术视野暴露、完整地分离“三个平面”及安全地处理“危险三角”等技术要点,直径≥10cm肾上腺肿瘤不再是腹腔镜手术的禁忌证。
Objective To summarize the operative points and clinical experience of laparoscopic surgery of adrenal tumors of diameter ≥10 cm. Methods From June 2011 to September 2012, 5 patients with adrenal tumors of 10cm in diameter underwent laparoscopic resection. The clinical effects were observed and the surgical approach and operation skills were analyzed and summarized. Results All the 5 cases underwent laparoscopic surgeries ≥10 cm of adrenalectomy were performed successfully. All of them were transperitoneal approaches with no intraoperative or postoperative complications. The operative time was 130-270 minutes (mean, 180 ± 65) min, intraoperative bleeding was 50 ~ 300ml. After 2 ~ 3d exhaust, discharged 5 ~ 7d. Pathological findings: 1 case of pheochromocytoma, 1 case of adrenocortical adenoma, 1 case of Schwannoma, 2 cases of medullary lipoma. Conclusions On the basis of skill, combined with accurate surgical approach, comfortable puncture cannula site, full surgical field exposure, complete separation of “three planes” and safe handling of “dangerous triangle” and so on Technical points, diameter ≥ 10cm Adrenal tumors are no longer contraindications to laparoscopic surgery.