肾上腺肿瘤腹腔镜手术两种手术径路的选择策略  

Selection strategy of two kinds of surgical routes for adrenal tumor patients undergoing laparoscopy

作　　者：余洪波 周文生[1] YU Hongbo;ZHOU Wensheng(Department of Urology,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233004

出　　处：《安徽医药》2018年第7期1335-1338,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨腹腔镜与后腹腔镜肾上腺肿瘤手术的临床价值。方法回顾分析26例行后腹腔镜肾上腺肿瘤手术(经后腹腔入路,后腹腔镜组)与23例行腹腔镜肾上腺肿瘤手术(经腹腔入路,腹腔镜组)的临床资料,统计分析两种手术方式的手术并发症发生率、手术时间、术中出血量、术后肠道通气时间、术后住院天数及肿瘤直径等。结果经腹腔入路者有1(4.3%)例因难以控制的肾上腺血管出血导致术野不清中转开放手术;经后腹腔入路者有2(7.7%)例中转开放手术,其中1例肾脏损伤,另1例因高碳酸血症中转开放。余46例手术均成功。经腹腔入路者手术时间(126±27.52)min;出血量(165.7±65.32)mL;术后(3.87±0.81)d通气;术后住院(9.83±2.39)d。经后腹腔入路者手术时间(110.77±26.14)min;出血量(149.04±50.05)mL;术后(1.88±0.77)d通气;术后住院(7.15±1.71)d。结论经腹腔入路与后腹腔入路手术方式各有其优缺点,在治疗上也没有明显的优劣之分。在实际临床工作中具体选择何种手术方式要根据患者的既往史、肿瘤大小与分期以及与周围器官、血管的相对位置关系来决定。Objective To explore the clinical value of laparoscopic and retroperitoneoscopic adrenal tumor surgery. Methods The clinical data of 26 patients undergoing laparoscopic adrenal tumor surgery（ post-peritoneal approach,retroperitoneoscopic group） and 23 patients undergoing laparoscopic adrenal tumor surgery（ transperitoneal approach,laparoscopic group） were retrospectively analyzed.The incidence of surgical complications,operative time,intraoperative blood loss,postoperative intestinal ventilation time,postoperative hospital stay and tumor diameter for the two surgical procedures were statistically analyzed. Results One（ 4. 3%） case of transabdominal approach resulted in unclear conversion of open surgical operation due to uncontrolled adrenal vascular hemorrhage; 2（ 7. 7%） cases of trans-abdominal approach had open surgery,including 1 case of kidney injury and the other of hypercapnia. More than 46 cases were successful. In the group through intraperitoneal approach,the operative time was（ 126 ± 27. 52） min,the intraoperative bleeding volume was（ 165. 7 ± 65. 32） mL,the postoperative intestinal ventilation time was（ 3. 87 ± 0. 81） d,the postoperative hospital stay was6 ~ 14 d,with an average of（ 9. 83 ± 2. 39） d. In the other group,the operative time was（ 110. 77 ± 26. 14） min,the intraoperative bleeding volume was（ 149. 04 ± 50. 05） mL,the postoperative intestinal ventilation time was（ 1. 88 ± 0. 77） d,the postoperative hospital stay was（ 7. 15 ± 1. 71） d. Conclusions Both surgical methods have their advantages and disadvantages,and there are no obvious advantages and disadvantages in the treatment. In the actual clinical work,the specific choice of surgical methods should be determined according to the patient＇ s previous history,tumor size and stage,and the relative position between the surrounding organs and blood vessels.

关 键 词：肾上腺肿瘤/外科学 腹腔镜检查 腹膜后间隙 

分 类 号：R736.6[医药卫生—肿瘤]