Corcione F, Esposito C, Cuccurullo D, Settembre A, Fusco F, Bianco A, Cusano T
Department of General Surgery, Monaldi Hospital, Naples, Italy.
Surg Endosc. 2001 Feb;15(2):218. doi: 10.1007/s004640040025. Epub 2000 Nov 7.
We report our experience with a case of vena cava injury during laparoscopic right adrenalectomy. A laparoscopic right adrenalectomy was performed in a 22-year-old woman who suffered from a right surrenalian adenoma. Four trocars were used for the transperitoneal laparoscopic approach with the patient in the lateral decubitus position. After isolation of the medial margin of the gland and clipping and sectioning of the main adrenal vein, the right side of the vena cava was injured during dissection of the right upper pole, due to the use of monopolar scissors. The hemorrhage was managed immediately with the aid of fenestrated atraumatic forceps and an aspiration probe. A fifth trocar was inserted to evaluate the size of the lesion, which was then sutured laparoscopically with croised 5/0 nonresorbable stitches. No transfusion was needed. Operating time was 210 min. The post-operative course was uneventful. Hospital stay was 7 days. At 10-month follow-up, the patient had no problems related to the intraoperative complication. Our preliminary experience shows that the laparoscopic approach enables safer management of lesions involving large abdominal vessels. We believe that the transperitoneal approach is the preferential route for laparoscopic adrenalectomies. Monopolar coagulation can be dangerous and must be avoided when dissecting large vessels.
我们报告了一例腹腔镜右肾上腺切除术期间腔静脉损伤的病例及处理经验。对一名患有右肾上腺腺瘤的22岁女性实施了腹腔镜右肾上腺切除术。采用经腹腹腔镜入路，患者取侧卧位，使用了4个套管针。在游离腺体的内侧边缘并夹闭和切断肾上腺主要静脉后，在分离右上极时因使用单极剪刀导致腔静脉右侧受损。立即借助带孔无损伤钳和吸引探头控制出血。插入第5个套管针以评估损伤大小，然后用5/0交叉不可吸收缝线进行腹腔镜缝合。无需输血。手术时间为210分钟。术后过程顺利。住院时间为7天。在10个月的随访中，患者未出现与术中并发症相关的问题。我们的初步经验表明，腹腔镜入路能够更安全地处理涉及腹部大血管的病变。我们认为经腹入路是腹腔镜肾上腺切除术的首选途径。在解剖大血管时，单极电凝可能很危险，必须避免。
