【摘要】 目的　探讨理想的肾上腺肿瘤手术径路。　方法　总结分析 1 0 77例不同类型、不同大小肾上腺肿瘤的手术径路和治疗效果。　结果　 567例产生醛固酮的肾上腺皮质肿瘤 (APA)和库兴综合征 (CUS)经 1 1、1 0肋间径路完成手术 ,9例经腹腔径路、6例用腹腔镜完成手术。嗜铬细胞瘤(phe)和偶发瘤经 1 1、1 0肋间径路手术者分别为 1 73例和 1 36例 ,经腹径路者分别为 1 36例和 2 2例 ,2 5例为胸腹联合径路 ,3例肿瘤 <4cm者采用腹腔镜手术。肿瘤切除 1 0 60例 ,活检 1 7例。 1 1、1 0肋间手术主要并发症是胸膜损伤 ,经腹手术主要并发症是脾损伤 ,本组脾切除共 9例。　结论　APA、CUS或 <7cm的 phe和偶发瘤采用 1 1、1 0肋肋间径路 ,>7cm肿瘤多采用经腹或经胸腹联合径路 ,多发和腹腔内肾上腺外 phe、双侧肾上腺肿瘤采用经腹径路 ,肾门区phe取 1 1、1 0肋间径路或胸腹联合径路较经腹径路能提供更多修复肾血管和保留肾的机会。 <6cm的肾上腺肿瘤可选用腹腔镜手术。更多还原

【Abstract】 Objective To identify the optimal surgical approaches for the resection of adrenal tumors. Methods The choices and effects of surgical approaches in 1 077 patients with adrenal tumors of varying sizes and types were analyzed. Results An 11th or 10th intercostal incision was used for 567 cases of aldosterone producing adrenocortical tumors (APA) and Cushing syndrome (CUS).An 11th or 10th incision was used in 173 cases of pheochromocytomas and 136 cases of incidental tumors.Transabdominal approach was performed in 136 cases of pheochromocytomas and 22 cases of incidental tumors.Twenty five patients receiving thoracoabdominal approach were all those with pheochromocytomas or incidental tumors.Nine patients with adrenal tomors less than 4 cm in diameter received laparoscopic surgery.Surgeries included 1 060 cases of tumor resection and 17 cases of biopsies,and splenectomy was procedured in 9 patients simultaneously. The main complication of 11th or 10th intercostal incision approach was pleural injury,and transabdominal approach had its main complication of spleen injury. Conclusions An 11th or 10th intercostal incision is the best choice for patients with APA,CUS and pheochromocytoma or incidental tumor less than 7 cm in diameter.For tumors greater than 7 cm,transabdominal or thoracoabdominal approach is indicated.Transabdominal approach is also indicated for extra adrenal or multiple pheochromocytomas and bilateral adrenal tumors.The 11th or 10th intercostal incisions or thoracoabdominal incisions provide more chances of renal vessel repair and renal sparing compared with transabdominal approach for pheochromocytomas adjacent to the renal vascular pedicle.Laparoscopic surgery is suitable for patients with adrenal tumors less than 6 cm in diameter.更多还原