腹腔镜下切除肾上腺髓性脂肪瘤疗效观察(1)
【摘要】目的 :探讨经腹腹腔镜下手术切除肾上腺髓性脂肪瘤的临床疗效。方法 : 回顾性分析8例肾上腺髓性脂肪瘤患者的临床资料。行彩超、CT及 MRI等影像学检查,术前诊断为肾上腺髓性脂肪瘤6例,嗜铬细胞瘤1例,肾上腺腺瘤1例。8例均行腹腔镜下肾上腺肿瘤切除术。结果:7例标准腹腔镜下切除肿瘤顺利完成,1例行手助腹腔镜下切除。术中1例血压出现波动,升高至180/116mmHg,余患者血压均稳定。平均手术时间1.5h,平均术中出血量 60 ml 。术后2～3d肠功能恢复,1～3d拔尿管,2～3d拔引流管,无明显外科并发症,术后平均7 d顺利出院。切除肿瘤3.0 cm×3.5 cm×4.0cm~ 5.5 cm×5.5 cm×6.0cm,病理诊断均为肾上腺髓性脂肪瘤。术后随访0.5～4年(平均2年),所有患者临床症状消失,彩超及CT检查未见肿瘤复发及恶性变。结论:经腹腹腔镜下手术切除肾上腺髓性脂肪瘤创伤小、疗效满意,为治疗本病的理想方法。
【关键词】肾上腺肿瘤;髓性脂肪瘤;手术;腹腔镜术
, 百拇医药
【中图分类号】R736.6 【文献标识码】A 【文章编号】1008-6455(2010)07-0033-02
Transperitoneal laparoscopic operation for adrenal myelolipoma
Meng Qingjun Wang Tiangang Gao Zhan
【Abstract】Objective: To evaluate the clinical experience of transperitoneal laparoscopic surgery for adrenal myelolipoma.Methods: The clinical data of 8 cases of adrenal myelolipoma (3 males, 5 females; mean age,44 years ) were analyzed .The diagnosis of adrenal myelolipoma was set up by B-ultrasound, CT or MRI exam. Preoperative diagnoses were adrenal myelolipoma in 6 cases, pheochromocytoma in 1 case ,adrenal tumor in 1 case. All cases underwent transperitoneal laparoscopic excision of adrenal myelolipoma . Results:All operations were completed successfully, including standard laparoscopic excision in 7cases, and hand-assisted laparoscopic excision in 1 case. The average operation time was 90 min, the average blood loss was 60 ml, and the average hospital stay after operation was 7 d. No surgical complications occurred. The tumor size was from 3.0 cm×3.5 cm×4.0cm to 5.5 cm×55 cm×6.0cm,andthe pathological reports showed adrenal myelolipoma . All the cases were followed up for 0.5 to 4 years, and there was no recurrence. Conclusions: Transperitoneal laparoscopic operation for adrenal myelolipoma could be as a good method because of its little trauma and quick recovery.
, 百拇医药
【Key words】Adrenal tumor; myelolipoma;operation; laparoscopy
肾上腺髓性脂肪瘤属于无功能良性肿瘤,临床较少见。近年来随着生化检查和影像学技术的提高,诊断率逐渐增加。我们2005~2010年经腹腔途径腹腔镜下切除肾上腺髓性脂肪瘤8例,效果满意,报告如下。
1 资料与方法
1.1 临床资料:本组8例。男3例,女5例。年龄29~59岁,平均44岁。左侧肾上腺肿瘤3例,右侧5例。血压高1例,腰腹部疼痛1例,伴有肥胖1例,体检或检查其它疾病偶然发现5例。实验室检查:血、尿常规,电解质,肝、肾功能均正常;1例24h尿游离皮质醇310nmol/24h(正常值88.3～257.9nmol/24h),1例香草扁桃酸74μmol/24h(正常值5～45μmol/24h),余6例内分泌检查均正常。8例均行彩超和CT检查。彩超示肾上腺区域内部回声均匀分布,声像图呈强回声占位性病变。CT检查表现为脂肪样低密度肿块,圆形或卵圆形,边界清,CT值-115~-10Hu,增强扫描无强化;散在团块样钙化组织,CT值15~40Hu,增强扫描呈轻度强化。MRI检查5例,表现为肾上腺区均质性脂肪样信号强度,T1、T2加权为高信号强度。肿瘤大小4~5.5cm,术前诊断为肾上腺髓性脂肪瘤6例,嗜铬细胞瘤1例,肾上腺腺瘤1例。
, http://www.100md.com
1.2 手术方法:全麻,60°-80°侧卧位。经脐缘穿刺气腹针注入CO2,建立气腹,压力至13-15mmHg,分别于脐缘、平脐腋前线及剑突下各穿入10mm或5mm套管作为腹腔镜及操作通道,右侧手术于肋缘下腋中线附近再穿入1套管作为辅助通道。打开侧腹膜,切断脾(或肝)结肠韧带,将肠管推向内侧,采用超声刀切开Gerota筋膜,游离肾上极周围脂肪,于肾上极相对无血管区寻找肾上腺及瘤体,以超声刀或Hem-o-lok仔细分离、结扎瘤体周围的粘连组织。根据肾上腺肿瘤的大小、位置采取相应的游离。若肿瘤较小、境界清楚,可单纯肿瘤切除;若肿瘤较大、与肾上腺紧贴分离困难,可与肾上腺一并切除。切除肾上腺应将肾上腺中央静脉游离结扎,左侧中央静脉较长、汇入左肾静脉、易游离,右侧较短、直接汇入下腔静脉、游离困难。
2 结果
7例患者标准腹腔镜下切除肿瘤顺利完成,1例右侧较大肿瘤与肝脏界面不清行手助腹腔镜下切除。术中1例血压出现波动,升高至180/116mmHg,余患者血压均稳定。8例手术时间1.0～2.5h,平均1.5 h;术中出血量40～100ml,平均60 ml ;切除肿瘤大小3.0 cm×3.5 cm×4.0cm~5.5 cm×5.5 cm×60cm,包膜完整,质地较软,切面呈淡黄、棕黄或暗褐色;术中无大血管及 邻 近 脏 器 损伤。术后2～3d肠功能恢复,1～3d拔尿管,2～3d拔引流管;术后5～9d,平均7 d顺利出院,出院时血压稳定,无明显外科并发症。术后病理报告肿瘤由成熟脂肪细胞和造血细胞组成,两者比例不一,分布不均,周围有正常肾上腺组织包绕,均诊断为肾上腺髓性脂肪瘤。出院后门诊随访5个月～4年,平均2年,所有患者临床症状消失,化验检查正常,复查彩超及CT未见肿瘤复发及恶性变。, http://www.100md.com
【关键词】肾上腺肿瘤;髓性脂肪瘤;手术;腹腔镜术
, 百拇医药
【中图分类号】R736.6 【文献标识码】A 【文章编号】1008-6455(2010)07-0033-02
Transperitoneal laparoscopic operation for adrenal myelolipoma
Meng Qingjun Wang Tiangang Gao Zhan
【Abstract】Objective: To evaluate the clinical experience of transperitoneal laparoscopic surgery for adrenal myelolipoma.Methods: The clinical data of 8 cases of adrenal myelolipoma (3 males, 5 females; mean age,44 years ) were analyzed .The diagnosis of adrenal myelolipoma was set up by B-ultrasound, CT or MRI exam. Preoperative diagnoses were adrenal myelolipoma in 6 cases, pheochromocytoma in 1 case ,adrenal tumor in 1 case. All cases underwent transperitoneal laparoscopic excision of adrenal myelolipoma . Results:All operations were completed successfully, including standard laparoscopic excision in 7cases, and hand-assisted laparoscopic excision in 1 case. The average operation time was 90 min, the average blood loss was 60 ml, and the average hospital stay after operation was 7 d. No surgical complications occurred. The tumor size was from 3.0 cm×3.5 cm×4.0cm to 5.5 cm×55 cm×6.0cm,andthe pathological reports showed adrenal myelolipoma . All the cases were followed up for 0.5 to 4 years, and there was no recurrence. Conclusions: Transperitoneal laparoscopic operation for adrenal myelolipoma could be as a good method because of its little trauma and quick recovery.
, 百拇医药
【Key words】Adrenal tumor; myelolipoma;operation; laparoscopy
肾上腺髓性脂肪瘤属于无功能良性肿瘤,临床较少见。近年来随着生化检查和影像学技术的提高,诊断率逐渐增加。我们2005~2010年经腹腔途径腹腔镜下切除肾上腺髓性脂肪瘤8例,效果满意,报告如下。
1 资料与方法
1.1 临床资料:本组8例。男3例,女5例。年龄29~59岁,平均44岁。左侧肾上腺肿瘤3例,右侧5例。血压高1例,腰腹部疼痛1例,伴有肥胖1例,体检或检查其它疾病偶然发现5例。实验室检查:血、尿常规,电解质,肝、肾功能均正常;1例24h尿游离皮质醇310nmol/24h(正常值88.3～257.9nmol/24h),1例香草扁桃酸74μmol/24h(正常值5～45μmol/24h),余6例内分泌检查均正常。8例均行彩超和CT检查。彩超示肾上腺区域内部回声均匀分布,声像图呈强回声占位性病变。CT检查表现为脂肪样低密度肿块,圆形或卵圆形,边界清,CT值-115~-10Hu,增强扫描无强化;散在团块样钙化组织,CT值15~40Hu,增强扫描呈轻度强化。MRI检查5例,表现为肾上腺区均质性脂肪样信号强度,T1、T2加权为高信号强度。肿瘤大小4~5.5cm,术前诊断为肾上腺髓性脂肪瘤6例,嗜铬细胞瘤1例,肾上腺腺瘤1例。
, http://www.100md.com
1.2 手术方法:全麻,60°-80°侧卧位。经脐缘穿刺气腹针注入CO2,建立气腹,压力至13-15mmHg,分别于脐缘、平脐腋前线及剑突下各穿入10mm或5mm套管作为腹腔镜及操作通道,右侧手术于肋缘下腋中线附近再穿入1套管作为辅助通道。打开侧腹膜,切断脾(或肝)结肠韧带,将肠管推向内侧,采用超声刀切开Gerota筋膜,游离肾上极周围脂肪,于肾上极相对无血管区寻找肾上腺及瘤体,以超声刀或Hem-o-lok仔细分离、结扎瘤体周围的粘连组织。根据肾上腺肿瘤的大小、位置采取相应的游离。若肿瘤较小、境界清楚,可单纯肿瘤切除;若肿瘤较大、与肾上腺紧贴分离困难,可与肾上腺一并切除。切除肾上腺应将肾上腺中央静脉游离结扎,左侧中央静脉较长、汇入左肾静脉、易游离,右侧较短、直接汇入下腔静脉、游离困难。
2 结果
7例患者标准腹腔镜下切除肿瘤顺利完成,1例右侧较大肿瘤与肝脏界面不清行手助腹腔镜下切除。术中1例血压出现波动,升高至180/116mmHg,余患者血压均稳定。8例手术时间1.0～2.5h,平均1.5 h;术中出血量40～100ml,平均60 ml ;切除肿瘤大小3.0 cm×3.5 cm×4.0cm~5.5 cm×5.5 cm×60cm,包膜完整,质地较软,切面呈淡黄、棕黄或暗褐色;术中无大血管及 邻 近 脏 器 损伤。术后2～3d肠功能恢复,1～3d拔尿管,2～3d拔引流管;术后5～9d,平均7 d顺利出院,出院时血压稳定,无明显外科并发症。术后病理报告肿瘤由成熟脂肪细胞和造血细胞组成,两者比例不一,分布不均,周围有正常肾上腺组织包绕,均诊断为肾上腺髓性脂肪瘤。出院后门诊随访5个月～4年,平均2年,所有患者临床症状消失,化验检查正常,复查彩超及CT未见肿瘤复发及恶性变。, http://www.100md.com