腹腔镜下肾上腺手术对肾上腺肿瘤的疗效及安全性分析  

Operation method and advantages of laparoscopic adrenal surgery

作　　者：王青富[1] Qing-fu Wang(Department of Urology, the First Affiliated Hospital of Nanyang Medical College,Nanyang, Henan 473000, China)

机构地区：[1]南阳医学高等专科学校第一附属医院泌尿外科,河南南阳473000

出　　处：《中国内镜杂志》2017年第5期69-73,共5页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜肾上腺手术对肾上腺肿瘤的治疗效果及其安全性。方法以2013年3月-2016年3月在该院接受治疗的90例肾上腺肿瘤患者为观察对象。并根据患者意愿分为腹腔镜组(48例)和开腹组(42例),观察两组患者的手术一般情况,比较两组患者术后炎症细胞因子水平、胃肠道积分、并发症和复发率情况。结果腹腔镜组患者的手术时间、住院时间、肠道功能恢复时间、术后拔管时间和术后引流量均少于开腹组(P<0.05);手术前,两组患者白细胞(WBC)、中性粒细胞比率(NEU%)、C反应蛋白(CRP)和血清白细胞介素-6(IL-6)水平差异无统计学意义,手术后第1、3和5天,两组患者的WBC、NEU%和IL-6水平均有所下降,但腹腔镜组下降更为明显。而两组患者的CRP浓度在手术后第1天均经历一个高峰期,之后的第3天和第5天较术后第1天下降,但都高于手术前,腹腔镜组患者术后各个时段的CRP浓度均低于开腹组(P<0.05);手术后,腹腔镜组患者肠鸣音、腹胀痛和胃肠道反应积分均明显低于开腹组(P<0.05);腹腔镜组术中腹膜损伤发生率和术后腹膜后血肿、切口感染、切口疝和肾上腺皮质功能低下发生率明显低于开腹组(P<0.05),两组术后复发率无明显差别(P>0.05)。结论腹腔镜肾上腺手术术式简单,可减少术中出血量,降低术后并发症发生率,值得在临床推广应用。Objective To investigate the therapeutic effect and safety of laparoscopic surgery for adrenaltumors.Methods90cases of adrenal tumors patients from March2013to March2016were selected as studysubjects and divided into laparoscopic group(48cases)and open surgery group(42cases)according to the wishesof the patients.The levels of inflammatory cytokines,gastrointestinal integration,complications and recurrencerate were compared between the two groups.Results The operation time,length of hospital stay,recovery timeof bowel function,extubation time and postoperative lead flow rate in laparoscopic group were less than that in theopen surgery group(P<0.05).Before surgery,the level of WBC,NEU%,CPR and IL-6of the two groups had nosignificant difference,1,3,5days after surgery,the level of WBC,NEU and IL-6groups were all decreased,but theobservation group decreased more significantly.The CPR concentrations of the two groups of children in the firstday after surgery were experiencing a peak period,after the first3days and5days which decreased than the firstday,but still higher than before the surgery,postoperative group of children CPR concentration of each period werelower than that in control group(P<0.05).After surgery,patients in the laparoscopic group borborygmus,abdominalpain and gastrointestinal reaction scores were significantly lower than that in laparotomy group(P<0.05);In the laparoscopic group,the incidence of peritoneal injury and postoperative retroperitoneal hematoma,incision infection,incision hernia and adrenal insufficiency was significantly lower than that in the open group(P<0.05),there wasno significant difference in recurrence rate between the two groups(P>0.05).Conclusions Laparoscopic adrenalsurgery is simple,which can reduce the amount of bleeding and reduce the incidence of postoperative complications,it is worth of promoting clinical application.

关 键 词：腹腔镜 肾上腺 炎症细胞因子 

分 类 号：R736.6[医药卫生—肿瘤]