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目的:初步总结机器人辅助腹腔镜切除肾上腺恶性肿瘤的经验,探讨其在肾上腺恶性肿瘤手术中的应用价值。方法:分析2015年2月~2016年8月间术前诊断为肾上腺恶性肿瘤9例患者的临床资料。9例患者均采用机器人辅助腹腔镜手术治疗。结果:所有手术均获成功,未中转开放。肿瘤位于左侧6例,右侧3例,肿瘤最大径3.1~15.5cm,平均7.1cm。肾上腺皮质癌4例、恶性嗜铬细胞瘤3例、肾上腺转移瘤2例。手术时间30~210min,平均85min。估计失血量50~1 100ml,平均270ml,2例需术中输血,均为肾上腺皮质癌。术后住院5~12d,平均8.5d。随访3~11个月,1例肾上腺皮质癌于术后6个月复诊时发现局部复发,其余患者随访期未见肿瘤复发。结论:机器人辅助腹腔镜切除肾上腺恶性肿瘤具有技术上的可行性,其视野和机械手臂灵活性的优势可能提高手术效果,但其肿瘤控制的远期疗效还需长期随访数据来证实。
OBJECTIVE: To summarize the experience of robot-assisted laparoscopic resection of adrenal malignancies and to explore its value in the surgical treatment of adrenal malignancies. Methods: Clinical data of 9 patients with adrenal malignancy diagnosed before surgery between February 2015 and August 2016 were analyzed. Nine patients were treated with robotic-assisted laparoscopic surgery. Results: All surgeries were successful and were not transferred to open. The tumor was located on the left side in 6 cases and on the right side in 3 cases. The maximum diameter of the tumor ranged from 3.1 cm to 15.5 cm with an average of 7.1 cm. 4 cases of adrenocortical cancer, 3 cases of malignant pheochromocytoma, adrenal metastases in 2 cases. Surgery time 30 ~ 210min, an average of 85min. Estimated blood loss 50 ~ 1 100ml, an average of 270ml, 2 cases required intraoperative blood transfusion, are adrenal cortical cancer. After hospitalization 5 ~ 12d, an average of 8.5d. Follow-up 3 to 11 months, 1 case of adrenal cortical cancer at 6 months after the referral found that local recurrence, the rest of the patients were followed up no tumor recurrence. Conclusions: Robot-assisted laparoscopic resection of adrenal malignancies is technically feasible. The advantages of visual field and mechanical arm flexibility may improve the surgical outcome. However, the long-term follow-up of long-term follow-up data is needed to confirm the long-term efficacy of tumor-controlled therapy.