摘要
目的 探讨腹腔镜下经腹入路行肾上腺手术的方法。方法 本组 4 2例 ,左侧 2 3例 ,右侧 19例。患者全侧卧位 ,经腹腔入路 ,采用 3～ 4个套管针 ,剪开侧腹膜显露肾上极内侧 ,将脾脏或肝脏游离后推开 ,切开肾上腺表面的肾周筋膜 ,游离肾上腺或腺瘤 ,用钛夹钳夹肾上腺中央静脉或肾上腺组织后 ,切除肾上腺或腺瘤。结果 4 1例于腹腔镜下顺利切除肾上腺或肿瘤。 1例嗜铬细胞瘤病例因肿瘤粘连紧密 ,改为开放手术。切出的瘤体直径 8～ 6 2mm。手术时间平均 82min。出血量平均 6 5ml。术后 5～ 7d出院。结论 采用全侧卧位 ,经腹腔入路手术解剖标记清楚有助于肾上腺及腺瘤的定位 ,避免损伤周围脏器及大血管 ,手术安全性高 ,适用于较大的腺瘤。
Objective\ To evaluate the laparoscopic surgery for adrenal diseases by transperitoneal approach.Methods\ Performed laparoscopic surgery in 42 cases of adrenal diseases, including 23 on the left and 19 on the right side. The operation was done in lateral decubitus through three or four ports. The colon was reflected medially by incising the line of Toldt, and Gerota′s fascia was exposed and opened to expose the adrenal gland or tumor. In order to reach adrenal gland the spleen and tail of pancreas should be reflected medially for left side and the liver need to be pushed upward for right side. The adrenal gland or the adrenal tumor was separated with electric hook or harmonic scalpel. The adrenal central vein should be clamped with clip and the adrenal artery and adrenal tissue could be divided with harmonic scalpel. The gland or the tumor was put in a plastic bag and removed.Results\ Laparoscopic procedures were completed in 41 cases. Only one pheochromocytoma had to be transferred to open surgery because of the severe adherence. The diameter of the specimen ranged from 8 to 62 mm. The mean operating time was 82 minutes. And the mean blood loss was 65 ml. There was no intraoperative or postoperative complication occurred in all cases.Conclusions\ The adrenal gland is easy to be exposed in lateral decubitus. Transperitoneal laparoscopic approach can provided clear anatomical landmark, which help to identify adrenal gland or tumor and avoid the injury of peripheral organ or large blood vessel. Transperitoneal laparoscopic procedure is suitable for pheochromocytoma, bigger tumor or the tumor in front of renal pedicle.
