腹腔镜无管化肾上腺切除术的临床应用  

Clinical application of tubeless laparoscopic adrenalectomy

作　　者：连文清 黄亚强[1] 黄红星[1] 钟睿 曹彬[1] LIAN Wen-qing;HUANG Ya-qiang;HUANG Hong-xing;ZHONG Rui;CAO Bin(Department of Urology,Zhongshan People′s Hospital,Zhongshan,Guangdong 528403,China)

机构地区：[1]中山市人民医院泌尿外科,广东中山528403

出　　处：《岭南现代临床外科》2024年第5期291-295,共5页Lingnan Modern Clinics in Surgery

基　　金：广东省中山市医学科研项目(20231A020007)。

摘　　要：目的探讨腹腔镜下无管化肾上腺切除手术的可行性和安全性。方法回顾性分析我院2022年6月~2024年7月收治的102例由同一诊疗团队医师行腹腔镜肾上腺切除术患者的临床资料。其中43例患者(无管化组)未放置切口引流管,术后即刻或术后1天内拔除导尿管。59例患者(对照组)常规放置切口引流管及导尿管。比较两组手术时间、术中出血量、术后开始进食时间、术后住院时间、术后疼痛视觉模拟评分(VAS)、术后并发症等之间的差异。然后比较经手术入路分层后围手术期临床指标的差异。结果两组手术均顺利完成,无中转开放手术。无管化组术后住院时间、术后2小时VAS疼痛评分、术后24小时VAS疼痛评分均优于对照组(均P<0.05)。两组患者手术时间、术中出血量、术后进食时间、术后并发症(发热、肺部感染、腹胀、尿潴留)发生率差异均无统计学意义(P>0.05)。基于不同手术入路的亚组分析显示,在经腹腔入路亚组,无管化组在手术时间、术后2小时VAS疼痛评分、术后24小时VAS疼痛评分、术后住院时间均显著优于对照组(P<0.05);在经腹膜后入路亚组,无管化组在术后24小时VAS疼痛评分、术后住院时间也显著优于对照组(P<0.05)。结论腹腔镜无管化肾上腺切除手术能够明显加速患者术后康复,提高患者舒适度,缩短住院时间,是一种安全可行的快速康复外科措施之一。Objective To explore the feasibility and safety of tubeless laparoscopic adrenalectomy.Methods A retrospective analysis was conducted on the clinical data of 102 patients who underwent laparoscopic adrenalectomy by the same surgical team at our hospital from June 2022 to July 2024.Among them,43 patients(tubeless group)did not have drainage tubes placed,and the urethral catheter was removed immediately or within 1 day after surgery.The remaining 59 patients(control group)underwent conventional drainage tube placement and urethral catheterization.The differences in surgical time,intraoperative bleeding,postoperative feeding time,postoperative hospital stay,postoperative pain visual analog score(VAS),and postoperative complications between the two groups were compared.Subgroup analysis was then performed based on surgical approach(transperitoneal vs.retroperitoneal)to compare perioperative clinical indicators.Results Both groups completed the surgery successfully without conver-sion to open surgery.The tubeless group had shorter postoperative hospital stays,lower VAS pain scores at 2 hours and 24 hours after surgery,compared to the control group(all P values less than 0.05).There were no significant differences in operative time,intraoperative bleeding,postoperative feeding time,and postoperative complications(fever,pulmonary infection,abdominal distension,and urinary reten-tion)between the two groups(all P values more than 0.05).Subgroup analysis based on surgical approach revealed that in the transperitoneal approach subgroup,the tubeless group showed significantly shorter operation times,lower VAS pain scores at 2 and 24 hours postoperatively,and shorter hospital stays compared to the control group(P<0.05).In the retroperitoneal approach subgroup,the tubeless group also showed significantly lower VAS pain scores at 24 hours postoperatively and shorter hospital stays(P<0.05).Conclusion Tubeless laparoscopic adrenalectomy can significantly accelerate postoperative recovery,improve patient comfort,and shorten hospit

关 键 词：无管化 肾上腺肿瘤 腹腔镜 肾上腺切除术 

分 类 号：R692[医药卫生—泌尿科学] R737.11[医药卫生—外科学]