Clinical effect analysis and experience summary of laparoscopic resection of largetumors in adrenal and adrenal areas via abdominal route
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摘要: 目的 探讨经腹腔路径腹腔镜手术切除肾上腺及肾上腺区巨大肿瘤的手术经验、技巧及安全性。方法 回顾性分析2012年3月—2022年8月山东第一医科大学附属省立医院收治的行腹腔镜手术治疗的82例肾上腺及肾上腺区巨大肿瘤患者的临床资料，统计手术成功率、手术时间、术中出血量、输血量、术后引流量、术后拔管时间、术后住院时间、围手术期并发症等情况。结果 82例患者手术入路均为经腹腔，其中左侧52例、右侧30例；肾上腺病变66例，肾上腺区病变16例。82例患者中，81例手术成功，无中转开放手术，1例因肿瘤粘连严重，转为腹腔镜肿瘤活检+减瘤术。手术时间30~360 min，平均(95.68±57.51) min；术中出血量10~1 500 mL，平均(119.37±224.90) mL；输血6例，输去白悬浮红细胞2.00~5.75 U，平均(3.96±1.19) U。术后前3 d引流量0~594 mL，平均(101.35±115.00) mL；术后拔管时间3~20 d，平均(5.84±2.64) d；术后住院时间4~23 d，平均(8.04±2.94) d；术后患者均未发生严重的围手术期并发症。结论 对于经验丰富的外科医生，经腹腔路径腹腔镜手术切除肾上腺及肾上腺区巨大肿瘤是安全可行的。Abstract: Objective To explore the surgical experience, operation technique and safety of laparoscopic resection of large tumors in adrenal and adrenal areas via abdominal approach.Methods A retrospective analysis was made of the clinical data of 82 patients with large adrenal or adrenal areas tumors who underwent laparoscopic surgery and were treated in Shandong Provincial Hospital Affiliated to Shandong First Medical University from March 2012 to August 2022. The achievement ratio of operation, operation time, intraoperative blood loss, blood transfusion volume, postoperative drainage volume, postoperative drainage tube extraction time, postoperative hospital stay, perioperative complications were counted.Results The surgical approach of 82 patients was via abdominal approach, including 52 cases on the left side, 30 cases on the right side, 66 cases of adrenal lesions, 16 cases of adrenal areas lesions. Among the 82 patients, 81 were successfully operated without conversion to open surgery. One patient underwent laparoscopic surgery and was converted to laparoscopic tumor biopsy plus tumor reduction due to severe tumor adhesion. The operation time was 30-360 min, and the average time was (95.68±57.51) min. Intraoperative blood loss ranged from 10 to 1 500 mL with an average of (119.37±224.90) mL. Six patients were transfused with red blood cells from 2.00 to 5.75 U, with an average of (3.96±1.19) U. In the first 3 days after surgery, the drainage volume was 0-594 mL, with an average of (101.35±115.00) mL. The postoperative extubation time was 3-20 days, with an average of (5.84±2.64) days. The postoperative hospital stay was 4-23 days, with an average of (8.04±2.94) days. No serious perioperative complications occurred in the patients.Conclusion For experienced surgeons, laparoscopic resection of large adrenal or adrenal areas tumors via abdominal approach is safe and feasible.
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