Gong Binbin, Ma Ming, Xie Wenjie, Yang Xiaorong, Sun Ting
The Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
J Surg Oncol. 2018 Apr;117(5):1066-1072. doi: 10.1002/jso.25002. Epub 2018 Feb 15.
To analyze our experience in retroperitoneal laparoscopic adrenalectomy (RLA) with transient renal artery occlusion for large adrenal tumors (≥8 cm) and to explore the safety and feasibility of this surgical procedure.
A retrospective cohort study was conducted with a surgical data review of 18 patients with large adrenal tumors who underwent RLA with transient renal artery occlusion in our hospital.
Eighteen patients were treated by RLA with transient occlusion of the renal artery, and none were converted to open adrenalectomy. The renal artery occlusion time, operative time, estimated blood loss, perirenal drainage time, postoperative hospital stay, and postoperative drainage were 7.6 ± 1.0 min, 176.3 ± 49.7 min, 247.2 ± 274.1 mL, 4.1 ± 1.02 days, 6.3 ± 1.4 days, and 73.6 ± 47.9 mL, respectively. No severe complications occurred, with the exception of hemodynamic instability in one patient with a pheochromocytoma and one transfusion during the operation. Only one case of adrenal crisis occurred postoperatively. Pathological examination revealed 9 cases of pheochromocytoma, 6 cases of adrenal myelolipoma, 1 case of adrenal ganglioneuroma, 1 case of hygromata, and 1 case of adrenal teratoma. No recurrence or evidence of metastasis was observed during the 7-to-30-month follow-up period.
RLA with transient renal artery occlusion is a feasible, effective, and safe treatment for large adrenal tumors (≥8 cm).
分析我院对大型肾上腺肿瘤（≥8厘米）行后腹腔镜肾上腺切除术（RLA）并暂时性肾动脉阻断的经验，探讨该手术方法的安全性和可行性。
进行一项回顾性队列研究，对我院18例行RLA并暂时性肾动脉阻断的大型肾上腺肿瘤患者的手术数据进行回顾。
18例患者接受了肾动脉暂时性阻断的RLA治疗，无一例转为开放性肾上腺切除术。肾动脉阻断时间、手术时间、估计失血量、肾周引流时间、术后住院时间和术后引流量分别为7.6±1.0分钟、176.3±49.7分钟、247.2±274.1毫升、4.1±1.02天、6.3±1.4天和73.6±47.9毫升。除1例嗜铬细胞瘤患者出现血流动力学不稳定和术中1次输血外，未发生严重并发症。术后仅发生1例肾上腺危象。病理检查显示嗜铬细胞瘤9例、肾上腺髓质脂肪瘤6例、肾上腺神经节瘤1例、淋巴管瘤1例、肾上腺畸胎瘤1例。在7至30个月的随访期内未观察到复发或转移迹象。
肾动脉暂时性阻断的RLA是治疗大型肾上腺肿瘤（≥8厘米）的一种可行、有效且安全的方法。
