腹腔镜外科杂志2017，Vol.22Issue(7)：481-485,5.DOI:10.13499/j.cnki.fqjwkzz.2017.07.481
基于肾上腺血管解剖的后腹腔镜肾上腺切除技术的改进及临床应用
A modified technique for retroperitoneal laparoscopic adrenalectomy based on adrenal vascular anatomy
周昱霖 1唐朝朋 2徐振宇 2位志峰 2徐晓峰 2董杰 2张征宇 2葛京平 2周文泉2
作者信息
- 1. 江苏大学附属人民医院,江苏 镇江,212002
- 2. 南京军区南京总医院
- 折叠
摘要
Abstract
Objective:To investigate a modified technique for retroperitoneal laparoscopic adrenalectomy based on adrenal vascular anatomy.Methods:The clinical data of 179 patients (92 males and 87 females) with adrenal tumors from Dec.2013 to May 2015 were analyzed retrospectively.The average age was (47.8±9.8) years (ranging from 12 to 79).Ninety-one cases had left-located tumor and 88 cases had right-located tumor.The tumor diameter was (2.8±1.3) cm in average (ranging from 0.8 to 11.5 cm).All patients underwent retroperitoneal laparoscopic adrenalectomy according to the following protocol:(1)After the retroperitoneal working space was created,Gerota fascia was dissected near the diaphragm to the crura of diaphragm,then the superior suprarenal artery was exposed and coagulated.(2)To dissect the middle and inferior suprarenal artery,surgeons dissected along with the plane between the renal artery and the inner margin of upper pole of kidney in order to divide the connective tissues that contained middle and inferior adrenal artery.(3)Then central adrenal vein was dissected and ligated in the triangle consisting of renal artery,inner margin of kidney and central adrenal vein.(4)Dissection was made between kidney and adrenal gland till the prerenal fusion fascia level.(5) Finally,the tumor was extracted after the surrounding tissues were separated.Results:All surgeries were successful with one conversion to open surgery.The average operative time was (30.2±10.3) min (ranging from 12 to 68 min),and the mean blood loss was (20.6±12.7) ml (ranging from 10 to 110 ml).All patients were discharged from the hospital in 1.5 to 3.9 d after surgery,the average postoperative hospital stay was (2.3±0.8) d.Peritoneum perforation occurred in two cases in operation but no relapse or metastasis was found during the follow-up.Conclusions:This novel technique can dissect blood supply directly and reduce the risk of bleeding.Also,this novel technique has simplified separation plane and there is no need to find tumor during surgery based on adrenal gland anatomy,the operation is time-saving and simple.关键词
肾上腺肿瘤/肾上腺切除术/腹腔镜检查/腹膜后路径/解剖Key words
Adrenal gland neoplasms/Adrenalectomy/Laparoscopy/Retroperitoneal approach/Dissection分类
医药卫生引用本文复制引用
周昱霖,唐朝朋,徐振宇,位志峰,徐晓峰,董杰,张征宇,葛京平,周文泉..基于肾上腺血管解剖的后腹腔镜肾上腺切除技术的改进及临床应用[J].腹腔镜外科杂志,2017,22(7):481-485,5.
