论文部分内容阅读
目的:基于对肾上腺血管解剖的理解,探讨后腹腔镜肾上腺切除术的新技术。方法:2013年12月至2015年5月共收治179例肾上腺肿瘤患者,其中男92例,女87例;肿瘤位于右侧88例,左侧91例;患者12~79岁,平均(47.8±9.8)岁;肿瘤直径0.8~11.5 cm,平均(2.8±1.3)cm。根据患者病情完善术前准备后均由同一术者根据以下策略行后腹腔镜肾上腺切除术:(1)腹膜后空间建立后沿腰大肌表面游离并纵行打开肾筋膜直至膈肌脚,寻及膈下动脉并结扎切断肾上腺上动脉;(2)寻及肾动脉,紧贴肾动脉及肾上极内侧缘夹角向深面游离,结扎肾上腺中、下动脉;(3)通过肾动脉及肾脏内侧缘所形成的“中央静脉三角”寻找肾上腺中央静脉并离断;(4)在肾脏、肾上腺之间游离,到达肾前融合筋膜层面,将肾上腺与肾脏重叠部分分离;(5)离断肾上腺周围相连的结缔组织,完整切除肾上腺。结果:178例手术获得成功,1例中转开放手术;手术时间12~68 min,平均(30.2±10.3)min;出血量10~110 ml,平均(20.6±12.7)ml;术后住院1.5~3.9 d,平均(2.3±0.8)d;2例术中出现腹膜损伤,术后随访期间未见肿瘤复发及转移。结论:此操作方法更加直接的处理肾上腺血供,减少了出血的几率,游离面较少,根据肾上腺解剖关系不用刻意寻找肾上腺肿瘤,操作更加省时、简单。
OBJECTIVE: To explore a new technique of retroperitoneoscopic adrenalectomy based on the understanding of adrenal vascular anatomy. METHODS: A total of 179 patients with adrenal tumors were enrolled from December 2013 to May 2015, including 92 males and 87 females. The tumors were located on the right side in 88 cases and on the left side in 91 cases. The patients were 12 to 79 years old with an average of 47.8 ± 9.8) years old; tumor diameter 0.8 ~ 11.5 cm, mean (2.8 ± 1.3) cm. According to the patient’s condition to improve preoperative preparation by the same surgeon according to the following strategy laparoscopic adrenalectomy: (1) after the establishment of retroperitoneal space along the psoas muscle surface free and longitudinally open renal fascia until the diaphragm feet, find And subphrenic artery and ligation of the adrenal artery; (2) to find the renal artery, close to the inner wall of the renal artery and renal pole angle to the deep surface free, ligation of the adrenal middle and lower artery; (3) through the renal artery and The middle of the kidney formed by the “central venous triangle” looking for adrenal central vein and off; (4) between the kidneys, adrenal free to reach the prerenal fusion fascia level, the adrenal and kidney overlap part of the separation; (5) ) Adjacent to the connective tissue around the adrenal, complete removal of the adrenal. Results: 178 cases were successfully operated and 1 case underwent open surgery. The operation time ranged from 12 to 68 minutes (mean, 30.2 ± 10.3) min. The bleeding volume was 10 to 110 ml (mean, 20.6 ± 12.7) ml. The postoperative hospital stay was 1.5 to 3.9 d, with an average of (2.3 ± 0.8) d. Peritoneal injury occurred in 2 cases and no tumor recurrence and metastasis were observed during follow-up. Conclusion: This method of treatment is more direct treatment of adrenal blood supply, reducing the risk of bleeding, less free surface, according to the anatomy of the adrenal gland without deliberately looking for adrenal tumors, the operation is more time-saving and simple.