腹腔镜、后腹腔镜与开放性手术治疗肾上腺肿瘤的比较分析  

Comparative study on transperitoneal retroperitoneal laparoscopic adrenalectomy and open adrenalectomy for adrenal tumours

作　　者：李仲宜[1] 龙慧民[1] 顾明祥[1] 杨燮樵[1] 殷民[1] 杨远清[1] 李如兵[1] 李宏[1] 

机构地区：[1]宁波大学医学院附属李惠利医院泌尿外科,浙江315041

出　　处：《中华外科杂志》2003年第8期617-619,共3页Chinese Journal of Surgery

摘　　要：目的　评价与比较前、后腹腔镜与开放性手术治疗肾上腺肿瘤的临床价值。　方法对 1996年 1月～ 2 0 0 2年 6月手术治疗的 81例肾上腺肿瘤进行回顾性分析。腹腔镜手术 19例中 17例成功 (A组 ) ,后腹腔镜手术 2 1例中 19例成功 (B组 ) ,开放性手术 4 1例 (C组 ) ,根据切除肿瘤平均重量、平均手术时间、术中平均出血量、肠功能平均恢复时间、术后平均住院时间、手术中转率、术后并发症等临床资料 ,对三组手术进行比较分析 ,并探讨手术适应证。　结果　切除肿瘤平均重量 :A组13 86g、B组 15 6 6g、C组 18 0 3g;平均手术时间 :A组比B组长 17 2 1min ,A、B二组分别比C组长4 8 5 3min和 31 32min ;术中平均出血量 :A、B二组分别比C组减少 12 1 5 5ml和 137 0 5ml,B组比A组减少 15 5 0ml;肠功能平均恢复时间 :A、B二组分别比C组提前 1 87d和 2 17d ,B组比A组提前0 3d ;术后平均住院时间 :A、B二组分别比C组缩短 2 6 0d和 3 87d ,B组比A组缩短 1 2 7d ;手术中转率 :A组 10 5 % (2 / 19)、B组 9 5 % (2 / 2 1) ;术后并发症 :A组 10 5 % (2 / 19)、B组 14 3% (3/ 2 1)、C组9 76 % (4/ 41)。　结论　两种腹腔镜手术各项比较指标均优于开放手术 ,后腹腔镜手术在入路便捷 。Objective To compare and evaluate the clinical value among transperitoneal, retroperitoneal laparoscopic adrenalectomy and open adrenalectomy for the treatment of adrenal tumours. Medthods From January 1996 to June 2002, transperitoneal laparoscopic adrenalectomy (TLA) was performed for 19 cases, 17 cases were successful (Group A), retroperitoneal laparoscopic adrenalectomy (RLA) for 21 cases,19 cases were successful (Group B), during the same period 41 patients with adrenal tumours under 6 cm in diameter underwent open adrenalectomy (Group C). The procedure was evaluated and compared in the respects of tumors weight, operation time,blood loss, recovery time of GI function,hospital stay, complications transferable rate and indications among three groups. Results Average tumors weight was (13 86)g in group A,(15 66)g in group B and (18 03)g in group C; mean operating time: group A was 17 21 min longer than group B, group A.B was 48 53 min longer and 31 32 min longer han group C respectively,mean blood loss in group A B was less diminished by 121 55 ml and 137 05 ml than group C, and the blood loss in group B was less diminished by 15 50 ml than group A;mean revovery of Gl function,group A and B was 1 87 day and 2 17 day earlier than group C respectively,group B was 0 3 day earlier than group A,mean hospital stay was 2 60 day and 3 87 day shortter than group C,group B was 1 27 day shortter, than group A;transfarable rate of operation was 10 5%(group A) and 9 5%(group B).Postoperative complication rate was 10 5%,14 3% and 9 7% in group A B and C respectively. Conclusions TLA and RLA were better than open method. On the hand of approach to adrenal gland distube to abdominal organ and postoperative recovery on RLA have some slight adventage.

关 键 词：腹腔镜 后腹腔镜 开放性手术 手术治疗 肾上腺肿瘤 手术入路 术后并发症 

分 类 号：R736.6[医药卫生—肿瘤] R730.56[医药卫生—临床医学]