149例肾上腺肿瘤后腹腔镜与开放手术疗效比较  

Retroperitoneal laparoscopic surgery versus open adrenalectomy： report of 149 cases

作　　者：范治璐[1] 孙伟[1] 于洋[1] 范维伟[1] 

机构地区：[1]大连医科大学附属二院泌尿外科

出　　处：《中华内分泌外科杂志》2011年第1期43-45,48,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的比较开放手术与后腹腔镜手术治疗肾上腺肿瘤的疗效。方法回顾性分析肾上腺肿瘤行开放性切除术30例（开放组）与行后腹腔镜手术119例（腔镜组）的临床资料，比较两组的手术时间、术中出血量、术后镇痛剂的使用、进食和拔除引流管时间、术后住院天数、并发症及术后肿瘤复发情况。开放组肿瘤直径0．5cm～10．8cmn，平均4．57cm；左侧18例，右侧12例。腔镜组肿瘤直径0．8cm～14．5cm，平均2．78cm；左侧59例，右侧60例。术后随访时间开放组6～72个月，腔镜组4～20个月。结果开放组30例全部成功，腔镜组12例改开放手术，因视野不清8例，肾动脉损伤1例，肿瘤太大1例，膈肌损伤1例，胸膜损伤1例。腔镜组手术时间、术中出血量、术后镇痛剂的使用、进食和拔除引流管时间、术后住院天数优于开放组，差异有统计学意义（P〈0．05）。结论肾上腺肿瘤行后腹腔镜切除术具有创伤小、术中出血少、术后恢复快等优点，已成为现代治疗肾上腺良性肿瘤的金标准。Objective To evaluate and compare open and retroperitoneal laparoscopic adrenalectomy. Methods Clinical data of 30 cases undergoing open adrenalectomy and 119 cases undergoing rctroperitoneal laparoscopic surgery, were retrospectively analyzed. The 2 groups were compared in terms of these aspects ： operation duration, intraoperative blood loss, postoperative analgesic use, time to remove drainage tube, time to resume eat, postoperative hospitalization time, complications, and tumor recurrence. In open surgery group, tumor diameter was between 0.5 cm -10.8 cm, 4.57 cm in average. 18 tumors were located on the left side and 12 tumors on the right side. In laparoscopic group, tumor diameter was between 0.8 cm -14.5 cm, 2.78 cm in average. 59 tumors were located on the left side and 60 tumors on the right side. Patients in open surgery group were followed up for 6-72 months and retroperitoneal laparoscopic group 4-20 months. Results Open adrenalectomy were suecessful in all the 30 cases. 12 cases in laparoscopic surgery group converted to open surgery among whom 8 cases were due to poor visibility, 1 case due to renal artery injury, 1 case due to large tumor size, 1 case because of diaphragmatic injury and 1 case because of pleural injury. Laparoscopic surgery was superior to open surgery in terms of operation duration, intraoperative blood loss, postoperative analgesic use, time to start food taking, time to remove drainage tube, and postoperative hospitalization time. The difference had statistical significance （P 〈 0.05）. Conclusion Retroperitoneal laparoscopic adrenalectomy has advantages such as less trauma, less blood loss, and shorter recovery time, which make this procedure the modern ＂golden standard＂ for treatment of benign adrenal neoplasm.

关 键 词：肾上腺肿瘤 后腹腔镜手术 肾上腺肿瘤切除术 

分 类 号：R736.6[医药卫生—肿瘤]