不同入路腹腔镜手术与开放手术在巨大肾上腺肿瘤切除中的对比研究  

Comparison of the treatment result of laparoscopic surgery via different approaches versus open surgery for large adrenal tumors

作　　者：汪涛[1] 黄慧[1] 潘晖[1] 曹阳惠 周章炎[1] 黄知刚 黄健[1] 

机构地区：[1]荆州市第一人民医院泌尿外科,湖北荆州434000

出　　处：《临床泌尿外科杂志》2017年第5期389-392,396,共5页Journal of Clinical Urology

摘　　要：目的:探讨不同手术方式在巨大肾上腺肿瘤(>6cm)切除术中的应用。方法:回顾性分析我院2012年1月~2016年12月行腹腔镜下巨大肾上腺肿瘤切除术的患者临床资料,根据手术入路不同分为经腹腔入路组(18例)与经腹膜后入路组(12例)。选取同期16例行开放经腹途径肾上腺肿瘤切除术的患者作为对照。比较三组患者的手术时间、术中失血量、术后住院时间、术后引流管保留时间及术后并发症等相关指标。结果:经腹腔入路组和经腹膜后入路组的手术时间显著少于开放手术组(P<0.05),但经腹腔入路组与经腹膜后入路组比较差异无统计学意义(P>0.05)。经腹腔入路组术中失血量显著少于经腹膜后入路组和开放手术组(P<0.05),但经腹膜后入路组与开放手术组比较差异无统计学意义(P>0.05)。经腹腔入路组和经腹膜后入路组术后住院时间显著短于开放手术组(P<0.05),但经腹腔入路组与经腹膜后入路组比较差异无统计学意义(P>0.05)。术后引流管保留时间及术后并发症三组间比较差异均无统计学意义(P>0.05)。结论:腹腔镜手术治疗巨大肾上腺肿瘤安全可行,对于腹腔镜手术操作娴熟的术者,经腹腔入路可能更具优势。Objective： To explore the application of different surgical procedures in the resection of large adre- nal tumor （〉6 cm）. Method： The clinical data of 30 patients with large adrenal tumors who underwent tumor re section by laparoscopic surgery from January 2012 to December 2016 were reviewed. They were divided into two groups according to the surgical approach. Eighteen patients in group one underwent the operation via intraperito- neal approach, and other 12 patients of group two via retroperitoneal approach. Sixteen patients who received lapa- rotomy were served as control group during the same period. Operation time, intraoperative blood loss, postopera- tive hospital stay and other clinical data were compared among three groups. Result： The operative time was sig- nificantly shorter in the two laparoscopic groups （groups one and two） than that in laparotomy group, with a sta- tistically significant difference （P（0.05）, but there was no statistically significant difference between two laparo- scopic groups （P〉0.05）. The volume of blood loss was less in intraperitoneal group than that in retroperitoneal group and laparotomy group （P〉0.05）, but there was no statistically significant difference between retroperito neal group and laparotomy group （P〉0.05）. The postoperative duration of hospital stay was shorter in the two laparoscopic groups than that in laparotomy group, with a statistically significant difference （P〈0.05）. There was no statistically significant difference in postoperative tube retention time and postoperative complication inci- dence among three groups （P〉0.05）. Conclusion： Laparoscopic surgery is safe and feasible for large adrenal tumors, and via intraperitoneal approach maybe better for skilled surgeons with sufficient experience.

关 键 词：腹腔镜手术 肾上腺肿瘤 巨大 开放手术 

分 类 号：R736.6[医药卫生—肿瘤]