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目的:探讨腹腔镜经腹入路肾上腺切除的手术技巧及临床经验。方法:对2011年9月~2015年9月收治的109例肾上腺疾病患者采用经腹入路肾上腺切除。患者采用完全健侧卧位,Hasson法(直视下切开法)全肋缘下放置穿刺套管,不切开侧腹膜,仅切开脾(肝)下后腹膜直达肾上腺解剖平面的整块切除手术方式。结果:109例手术均获成功,手术时间为45~185min,术中出血10~350ml,住院时间为3~47d,中位数6d。术后病理诊断为嗜铬细胞瘤10例、肾上腺髓质脂肪瘤5例、肾上腺髓质增生症6例、肾上腺囊肿8例、肾上腺皮质腺瘤61例、肾上腺皮质增生17例、神经纤维瘤2例。结论:经腹入路腹腔镜肾上腺手术具有手术空间大、解剖标志清晰固定、便于学习掌握等优点,经过改良后,可降低这一术式对腹腔脏器的干扰,同时可以减少术中肾上腺组织的刺激,避免了血压波动,尤其适用于大体积肾上腺瘤及嗜铬细胞瘤的治疗。
Objective: To explore the surgical technique and clinical experience of laparoscopic transabdominal adrenalectomy. METHODS: One hundred and ninety-nine patients with adrenal diseases admitted from September 2011 to September 2015 underwent transabdominal adrenalectomy. The patient was in a fully contralateral position. The Hasson method (incision method under direct vision) was used to place a puncture cannula under the full rib margin. The lateral peritoneum was not dissected. Only the peritoneal mass of the adrenal gland dissection plane Removal of surgical methods. Results: All the 109 cases were successful. The operative time ranged from 45 to 185 minutes. The intraoperative bleeding ranged from 10 to 350ml. The length of stay was from 3 to 47 days. The median time was 6 days. Postoperative pathological diagnosis of pheochromocytoma in 10 cases, 5 cases of adrenal medullary lipoma, 6 cases of adrenal medulla, 8 cases of adrenal cysts, 61 cases of adrenal cortical adenoma, 17 cases of adrenal hyperplasia, neurofibroma 2 example. Conclusion: The transabdominal laparoscopic adrenalectomy has the advantages of large operation space, clear anatomic landmarks, easy learning and mastery, and so on. The improved laparoscopic adrenalectomy can reduce the interference of this technique on abdominal organs and reduce the intraoperative adrenal tissue Of the stimulus, to avoid fluctuations in blood pressure, especially for large volume adrenal tumors and pheochromocytoma treatment.