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目的总结改良肋缘下切口途径切除巨大肾上腺肿瘤的临床应用效果。方法巨大肾上腺肿瘤患者22例,均经改良肋缘下切口途径完成肿瘤切除手术。患者平卧,手术切口从剑突中线下行,沿肋弓转向十一肋间,分别在肋弓和剑突下作二个弯曲;在肥胖体型患者则可延长切口切断腹直肌并过中线。术侧腰背部垫高30度,升高腰桥少许,并应用框架挂钩辅助暴露。结果 22例患者肿瘤直径均大于10cm,其中4例肿瘤直径大于15cm。因肿瘤侵犯而同时施行肝叶部分切除1例。中位手术时间为2.8h。随访6个月～2年,无并发症发生。结论改良肋缘下切口便于腹腔脏器探查,膈下和大血管暴露良好,是巨大肾上腺肿瘤手术的良好选择。
Objective To summarize the clinical effect of using modified inferior incision approach to remove giant adrenal tumors. Methods Twenty-two patients with huge adrenal tumors were treated by tumor resection via modified inferior incision. Patients supine, surgical incision down from the Xiphoid line, along the rib bow to eleven intercostals, respectively, in the ribs bow and xiphoid two bends; in obese patients can extend the length of the incision and cut off the rectus abdominis and the midline. Side of the back of the operation pad 30 degrees high, a little elevated lumbar bridge, and the application of frame-linked auxiliary exposure. Results Twenty-two patients had a tumor diameter greater than 10 cm, of which 4 had a tumor diameter greater than 15 cm. One case of partial hepatectomy due to tumor invasion. The median operation time was 2.8h. Follow-up 6 months to 2 years, no complications. Conclusion The improved incision under the costal margin facilitates the exploration of the abdominal organs and the good exposure of the subadiponectomy and the large blood vessels. It is a good choice for the surgery of giant adrenal tumors.