自制单孔后腹腔镜解剖性肾上腺肿瘤切除术

Single-port anatomical retroperitoneal laparoscopic adrenalectomy by using self-made port

摘要:

目的 初步探讨自制套管单孔后腹腔镜肾上腺肿瘤切除术的可行性和安全性。 方法 2010年1月～2012年11月，对21例肾上腺肿瘤患者行单孔后腹腔镜下解剖性肾上腺肿瘤切除术。男14例，女7例，平均43（19～56）岁，平均体质量指数23.4 kg/m2；均为腹膜后入路。 结果 瘤体直径1.5～4.0 cm，左侧8例，右侧13例；无功能皮质腺瘤4例，醛固酮瘤13例，肾上腺囊肿2例，淋巴血管瘤1例，嗜铬细胞瘤1例。21例手术均顺利完成，无中转开放及转为标准腹腔镜手术，手术时间（92.8±21.6）min，出血量（64.3±11.3）mL，术中无并发症发生，术后第1天疼痛评分0～3分，未用镇痛剂，术后平均住院时间4 d，短期随访无术后并发症发生，醛固酮瘤患者血钾均恢复至正常范围，2例血压下降但仍需服用降压药物。 结论 采用自制套管行单孔后腹腔镜下解剖性肾上腺肿瘤切除术具有安全、有效及操作方便等优点，具有良好的应用前景。但具体收益尚需更进一步的来自良好实验设计的数据来论证。

Abstract:

【Objective】 To explore the safety and feasibility of single-port anatomical retroperitoneal laparoscopic adrenalectomy by using a self-made port. 【Methods】 From January 2009 to November 2012, single-port anatomical retroperitoneal laparoscopic adrenalectomy was performed by using a self-made port in 21 patients (14 men and 7 women) with adrenal tumor. The mean patient age was 43(19~56) years. The mean body mass index was 23.4 kg/m2. 【Results】21 cases were completed successfully without conversion to open or standard laparoscopic surgery. The mean operative time was (92.8±21.6) min, the mean blood loss was (64.3±11.3) mL, no major complication occurred during surgery. The post-operative pain score (VAPS) in the first post-operative day was 0~3, none of the patients received analgesic. The mean post-operative hospital stay was 4 days, No post-operative complications was observed after a short-term follow-up. The serum potassium level of patients with aldosterone-producing adenoma were returned to normal range, the blood pressure in 2 patients after surgery was still higher than normal, but needed less antihypertensive medications compared with pre-operation. 【Conclusion】 The self-made triport in the single-site anatomical retroperitoneal laparoscopic adrenalectomy is safe and feasible, and is of a fine clinical application prospect. However, these results should be further proved by large-scale random control trials.