论文部分内容阅读
目的总结经腹腔、经后腹腔途径腹腔镜肾上腺肿瘤切除术的临床经验。方法2001年12月~2004年12月,我院施行腹腔镜肾上腺切除术56例。采用经腹腔途径肾上腺肿瘤切除术10例,腹部取3个trocar穿刺入路,切开侧腹膜和肾周筋膜,在肾上极内上方分离肾上腺或瘤体,结扎速结合超声刀将肿瘤切除。经后腹腔途径切除肾上腺肿瘤46例,腰部取3个trocar穿刺入路,用自制的气囊扩张后腹腔,切开肾周筋膜,在肾上极内上方分离肾上腺或瘤体,结扎速结合超声刀将肿瘤切除。结果10例经腹腔途径中3例因腹腔广泛粘连中转开放手术,46例经后腹腔途径中1例因下腔静脉损伤大出血中转开放手术。余52例术中出血量20~200 m l,平均70 m l,均未输血。手术时间40~200 m in,平均110 m in。术后住院3~8 d,平均5.4 d。52例随访6~36个月,平均8个月,未见肿瘤复发和转移。结论腹腔镜肾上腺切除术效果确切,损伤小,术后恢复快,住院时间短,是肾上腺手术的首选术式。
Objective To summarize the clinical experience of transperitoneal and retroperitoneal laparoscopic adrenalectomy. Methods From December 2001 to December 2004, 56 cases of laparoscopic adrenalectomy were performed in our hospital. 10 cases of adrenal tumor resection by abdominal route, 3 trocar puncture approach in the abdomen, lateral peritoneum and perirenal fascia were excised, the adrenal gland or tumor was separated in the upper part of the kidney, and the tumor was excised by ligating the speed with the ultrasonic knife . 46 cases of adrenal tumors were resected by retroperitoneal approach, 3 trocar puncture approachs were performed in the lumbar region, and the peritoneal cavity was expanded with self-made balloon. The adrenal gland or tumor was excised from above the upper pole of the kidney. The speed of ligation combined with ultrasonography Knife will remove the tumor. Results Among the 10 cases, 3 cases underwent peritoneal extensive adhesions and 3 cases underwent transabdominal surgery. One case of 46 cases underwent retroperitoneal approach because of inferior vena cava hemorrhage. The remaining 52 cases of intraoperative bleeding 20 ~ 200 m l, an average of 70 m l, were not transfused. Surgery time 40 ~ 200 m in, an average of 110 m in. After hospitalization 3 ~ 8 d, an average of 5.4 d. 52 cases were followed up for 6 to 36 months, an average of 8 months, no tumor recurrence and metastasis. Conclusions Laparoscopic adrenalectomy has the exact effect, small injury, quick recovery after surgery and short hospital stay. It is the first choice for adrenalectomy.