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目的:探讨分析巨大(直径≥6cm)肾上腺肿瘤行腹腔镜手术的有效性和安全性。方法:回顾分析为29例巨大肾上腺肿瘤患者行腹腔镜手术的临床资料。结果:29例均顺利施行腹腔镜肾上腺肿瘤切除术,经腹腔途径17例,经腹膜后途径12例。肿瘤直径6.0~9.5cm,平均(6.7±2.5)cm,手术时间85~180min,平均(98±35)min,术中出血90~1200ml,平均(225±87)ml,术后胃肠功能恢复时间24~70h,平均(38±25)h,术后2~3d拔除引流管,术后住院6~10d,平均(5.7±2.3)d。随访12~36个月,平均20.5个月,27例患者临床症状消失,2例皮质腺癌复发。结论:螺旋CT及三维重建可为巨大肾上腺肿瘤患者的进一步治疗提供指导。随着技术的不断进步,巨大肾上腺肿瘤不再是腹腔镜手术的绝对禁忌证,腹腔镜手术安全、有效,已成为巨大肾上腺肿瘤患者可选择的有效术式。
Objective: To investigate the effectiveness and safety of laparoscopic surgery in the analysis of giant (≥6 cm in diameter) adrenal tumors. Methods: A retrospective analysis of 29 cases of giant adrenal tumors in patients undergoing laparoscopic surgery clinical data. Results: All of the 29 patients underwent laparoscopic adrenalectomy successfully. There were 17 cases by intraperitoneal route and 12 by retroperitoneal route. The tumor diameter was 6.0 ~ 9.5cm, with an average of (6.7 ± 2.5) cm. The operation time ranged from 85 to 180 minutes, with an average of (98 ± 35) minutes. The intraoperative bleeding ranged from 90 to 1,200ml (mean ± SD 225 ± 87) The time ranged from 24 to 70 hours, with an average of (38 ± 25) hours. Drainage tubes were removed 2 to 3 days after operation. The patients were hospitalized for 6 to 10 days with an average of (5.7 ± 2.3) days. All patients were followed up for 12-36 months (average 20.5 months). The clinical symptoms of 27 patients disappeared and 2 cases of recurrence of cortical adenocarcinoma. Conclusion: Spiral CT and three-dimensional reconstruction can provide guidance for the further treatment of patients with giant adrenal tumors. With the continuous improvement of technology, huge adrenal tumor is no longer an absolute contraindication to laparoscopic surgery. Laparoscopic surgery is safe and effective and has become an effective and effective procedure for patients with huge adrenal tumors.