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目的:探讨后腹腔镜下肾上腺疾病术中并发症的预防及处理。方法:回顾性分析2010年10月~2016年10月我院收治的582例肾上腺疾病患者。男265例,女317例。年龄14~78岁,平均47.3岁。左侧356例,右侧226例。肿瘤最大径1.0~14.5cm,平均3.2cm,其中肿瘤>6.0cm者59例。所有患者均进行充分术前准备。结果:所有患者均行后腹腔镜下肾上腺切除术,手术时间为25~180min,平均45.2min。术中出血量为10~400ml,平均26.4ml。出现并发症者51例(8.8%),其中腹膜损伤29例(5.0%),皮下气肿21例(3.6%),明显出血18例(3.1%),膈肌损伤4例(0.7%),肾脏损伤4例(0.7%)。术中因出血而输血者4例,11例因出血或脏器损伤改开放手术。结论:经后腹腔入路腹腔镜手术治疗肾上腺疾病安全有效,对肾上腺解剖结构的充分掌握及熟练的腹腔镜技术可有效预防并发症的发生。
Objective: To study the prevention and treatment of intraoperative complications of retroperitoneal laparoscopic adrenal disease. Methods: A retrospective analysis of 582 cases of adrenal diseases admitted to our hospital from October 2010 to October 2016 was performed. There were 265 males and 317 females. Aged 14 to 78 years old, with an average of 47.3 years old. 356 cases on the left and 226 cases on the right. The largest tumor diameter 1.0 ~ 14.5cm, an average of 3.2cm, of which tumor> 6.0cm in 59 cases. All patients were fully preoperative preparation. Results: All patients underwent laparoscopic retroperitoneal laparoscopic surgery. The operation time was 25 ~ 180min with an average of 45.2min. Intraoperative bleeding was 10 ~ 400ml, an average of 26.4ml. There were 51 cases (8.8%) with complications, including 29 cases of peritoneal injury (5.0%), 21 cases of subcutaneous emphysema (3.6%), 18 cases of obvious bleeding (3.1%), 4 cases of diaphragmatic injury (0.7% Injury in 4 cases (0.7%). Intraoperative blood transfusions in 4 cases, 11 cases due to bleeding or organ injury to open surgery. Conclusion: Retroperitoneal laparoscopic surgery for adrenal diseases is safe and effective. Adequate mastery of the adrenal anatomy and skilled laparoscopic techniques can effectively prevent the occurrence of complications.