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目的:评价后腹腔镜手术切除较大肾上腺肿瘤的安全性和可行性。方法:回顾性分析北京大学第三医院泌尿外科2004年7月至2008年12月经后腹腔途径行肾上腺肿瘤切除病例的临床资料,根据肿瘤的最大径分为2组,其中A组肿瘤最大径≥6cm[13例,年龄45±18岁,肿瘤直径(7.6±1.2)cm],B组肿瘤直径在3～6cm[40例,年龄49±12岁,肿瘤直径(4.0±0.9)cm]。结果:所有手术均较顺利完成,A组和B组之间手术时间[(127±77)minvs(107±47)min,P<0.05]、出血量[(167±223)mLvs(65±60)mL,P<0.01]差异均有统计学意义,术中并发症发生率和输血率A组高于B组(23%vs12.5%和15%vs2.5%),术后住院时间差异无统计学意义[(7.1±1.1)dvs(5.5±0.7)d,P>0.05]。A组随访25±14月,8例B超未见局部复发,失访3例,2例发现肾积水等异常;B组随访29±14个月,30例未见术后复发,失访9例,1例肾功能不全;A组术后病理以髓样脂肪瘤(30.8%)、嗜铬细胞瘤(23%)和神经节细胞瘤(23%)为主;B组病理以皮质腺瘤(32.5%)、嗜铬细胞瘤(25%)和髓样脂肪瘤(17.5%)为主。结论:后腹腔镜肾上腺肿瘤切除术治疗肾上腺肿瘤效果良好,对于有一定经验的术者,可以安全地经后腹腔镜途径切除最大直径为6cm以上的复杂肾上腺肿瘤。
Objective: To evaluate the safety and feasibility of retroperitoneal laparoscopic resection of large adrenal tumors. Methods: The clinical data of patients with adrenal tumors resected by retroperitoneal approach from July 2004 to December 2008 in Department of Urology, Peking University Third Hospital were retrospectively analyzed. According to the maximum diameter of tumors, the patients were divided into two groups. The maximum diameter of tumor in group A was ≥ The diameter of tumor in group B was 3 ~ 6 cm [40 cases, age 49 ± 12 years, tumor diameter (4.0 ± 0.9) cm] in 6 cm [13 patients, 45 ± 18 years of age, and tumor diameter of 7.6 ± 1.2 cm]. Results: All the operations were completed successfully. The operation time between group A and group B was (127 ± 77) minutes vs 107 ± 47 minutes (P <0.05), and the blood loss was (167 ± 223) mL vs ) mL, P <0.01]. The incidence of intraoperative complications and blood transfusion was higher in group A than in group B (23% vs 12.5% and 15% vs 2.5%), and the difference in postoperative hospital stay No statistical significance [(7.1 ± 1.1) d vs (5.5 ± 0.7) d, P> 0.05]. In group A, follow-up was 25 ± 14 months. No local recurrence was found in 8 cases of B-ultrasound, 3 cases were lost to follow-up, and 2 cases were found abnormal hydronephrosis. Group B was followed up for 29 ± 14 months. No recurrence was found in 30 cases, 9 cases, 1 case of renal insufficiency; the pathology of group A was mainly myeloid lipoma (30.8%), pheochromocytoma (23%) and ganglioneuroma (23%); (32.5%), pheochromocytoma (25%) and myeloid lipoma (17.5%). Conclusions: Retroperitoneal laparoscopic adrenalectomy for the treatment of adrenal tumors has a good effect. For patients who have some experience, laparoscopic resection of complex adrenal tumors with a maximum diameter of 6 cm or more can be safely performed.