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目的探讨肾上腺小肿瘤的后腹腔镜手术治疗体会。方法回顾性分析2005年9月至2008年12月我院施行的389例后腹腔镜肾上腺切除术的临床资料,其中肾上腺小肿瘤96例,分成最初40例组和后期56例组。术前所有病例行CT形态定位检查。所有手术均经后腹膜入路完成。结果96例肾上腺肿瘤平均大小0.7 cm(0.5~1.0 cm),其中原醛76例(单侧腺瘤69例、单侧皮质增生7例),无功能性腺瘤11例,库欣综合症3例,嗜铬细胞瘤2例,黑素瘤1例,髓样脂肪瘤1例,转移癌1例。4例(3.5%)中转开放手术。最初40例组的手术时间明显长于随后的56例组(P<0.01),两组术中出血量无明显差异。结论尽管腹腔镜技术是治疗良性肾上腺肿瘤的金标准,但对于肾上腺小肿瘤,腹腔镜手术有一定难度,术中先游离寻找靠近后腹膜的肾上腺内侧支、充分游离及探查整个肾上腺组织是手术成功的关键。
Objective To investigate the experience of retroperitoneal laparoscopic surgery for adrenal small tumors. Methods The clinical data of 389 cases of retroperitoneal laparoscopic adrenalectomy performed in our hospital from September 2005 to December 2008 were retrospectively analyzed. 96 cases of adrenal small tumors were divided into the first 40 cases and the later 56 cases. All patients underwent preoperative CT morphological localization examination. All surgeries were completed by retroperitoneal approach. Results The average size of 96 adrenal tumors was 0.7 cm (0.5-1.0 cm). There were 76 cases of primary aldehyde (69 cases of unilateral adenoma and 7 cases of unilateral cortical hyperplasia), 11 cases of non-functioning adenoma, 3 cases of Cushing’s syndrome , 2 cases of pheochromocytoma, 1 case of melanoma, 1 case of myeloid lipoma and 1 case of metastatic carcinoma. 4 cases (3.5%) were transferred to open surgery. The initial operation time was significantly longer in the 40 patients than in the subsequent 56 patients (P <0.01). There was no significant difference in the amount of bleeding between the two groups. Conclusions Although laparoscopy is the gold standard for the treatment of benign adrenal tumors, it is difficult for adrenal tumors and laparoscopic surgeries to find the medial branch of the adrenal gland proximal to the retroperitoneal space, to be completely free and to probe the entire adrenal gland successfully key.