摘要
目的：比较经腹腔与腹膜后腹腔镜肾上腺肿瘤切除术的不同特点,探讨腹腔镜肾上腺肿瘤切除术的入路选择。方法：回顾分析2002年6月至2008年8月我院施行的腹腔镜肾上腺肿瘤切除术356例患者的临床资料,经腹腔途径205例,经腹膜后途径151例,比较两组的肿瘤直径、手术时间、术中出血量、肠功能恢复时间、开始下床时间、术后住院时间、围手术期并发症等,根据两组不同年份的平均手术时间绘制学习曲线。术后对患者血压、电解质及内分泌指标进行随访,比较两组的手术效果。结果：肿瘤平均直径、平均手术时间、术中平均出血量、肠功能平均恢复时间、平均开始下床时间、术后平均住院时间两组差异均无统计学意义（P〉0.05）。两组均未输血及中转开放手术。经腹腔组术中1例脾被膜损伤,经腹膜后组术中无并发症发生,1例术后第5天出现下肢深静脉血栓。学习曲线显示两组随手术例数增加,平均手术时间均逐渐缩短,但经腹膜后组有一段快速下降曲线,经腹腔组下降曲线则较为平缓。所有患者均获随访1～68个月,平均21.5个月,均未出现生化指标复发。结论：两种腹腔镜手术入路各有优点,效果相当,入路的选择主要根据肿瘤的位置和术者的手术经验决定。
Objective：To compare the characteristics of transperitoneal and retroperitoneal laparoscopic adrenal tumorectomy and investigate the approach of laparoscopic adrenal tumorectomy. Methods ： The clinical data of 356 cases of laparoscopic adrenal tumorectomy were retrospectively analyzed from Jun. 2002 to Aug. 2008, of which 205 cases were in transperitoneal approach, 151 were in retroperitoneal approach. The mean data of tumor size, operative time, blood loss, time to postoperative intake, time to ambulation, postoperative hospital stay and perioperative complications were compared and analyzed between the transperitoneal and retroperitoneal groups. The learning curves were drawn according to the mean operating time of all cases performed within a year in each group. Blood pressure, electrolyte and relevant endocrine markers of these patients were monitored during the follow-up. The intraoperative and postoperative effect of the two approaches were compared and assessed. Results： Mean tumor size was 2.9cm in transperitoneal group, 2.7cm in retroperitoneal group （ P 〉 0.05 ）. Mean operative time in transperitoneal group was 76.6min, in retroperitoneal group was 78. 3min （ P 〉 0.05 ）. Mean blood loss were 34.8ml and 36.3ml in the transperitoneal and retroperitoneal groups respectively （ P 〉 0. 05）. Mean time to postoperative intake was 27.2h in transperitoneal group and 26.6h in retroperitoneal group （P 〉0.05）. Mean time to ambulation were 25.8h and 24.9h （P 〉0.05） ,mean postoperative hospital stay were 6.8d and 6.5d （P 〉0.05） in the transperitoneal and retroperitoneal groups respectively. There was no blood transfusion or conversion to open surgery in two groups. The perioperative complications included a splenic capsule tear of intraoperative complication in transperitoneal group and a deep venous thrombosis in lower limb of postoperative complication 5 days after the operation in retroperitoneal group. In both approaches, mean operation time showed decline trend as more cases were accumulated. The learning curve demonstrated a steep decreasing phase in retroperitoneal group comparing with a mild decreasing curve in transperitoneal group. No recurrence was detected biochemically during a mean followup of 21.5 months （range 1-68 months）. Conclusions： Both transperitoneal and retroperitoneal laparoscopic adrenaleetomy are safe and effective. The location of tumor and operator＇s experiences are the dominating factors in selecting the approach.
出处
《腹腔镜外科杂志》
2009年第8期582-584,共3页
Journal of Laparoscopic Surgery
