经腹单孔多通道腹腔镜与标准腹腔镜肾上腺切除术对比研究

Comparison of transperitoneal laparoendoscopic single-site surgery and standard laparoscopic adrenalectomy

目的:探讨经腹单孔腹腔镜肾上腺切除术的可行性,安全性和有效性,并与标准经腹腹腔镜肾上腺切除术对照分析,评价其临床优势。方法:对经腹单孔腹腔镜肾上腺切除术13例和标准经腹腹腔镜肾上腺切除术26例患者的临床资料和随访资料进行统计学分析。结果:两组患者在基线水平,术中出血,术后住院时间方面差异无统计学意义。单孔腹腔镜手术组手术时间较标准腹腔镜手术组长(148.5:112.9 min,P=0.032),但在术后疼痛评分(2.3:3.7,P=0.001)、术后需阿片类镇痛药人数比例(30.8%:73.1%,P=0.011)、术后进食时间(21.6:26.0 h,P=0.002)、皮肤切口长度(2.3:5.9 cm,P<0.001)及满意度方面(9.5:9.1,P=0.042),单孔腹腔镜手术组患者均优于标准腹腔镜手术组患者。术后第1年随访结束时,两组患者均无肿瘤复发,且无药物无法控制的症状。结论:经腹单孔腹腔镜肾上腺切除术安全、可行、有效、且与标准腹腔镜肾上腺切除术相比,尽管手术时间略长,但具有患者术后疼痛轻,镇痛药物需要量少,肠道通气快,皮肤切口小及满意度高的优点。

Objective:To evaluate the feasibility,safety,and efficacy of transperitoneal laparoendoscopic singlesite(LESS) adrenalectomy and seek to whether it indicates advantages compared with standard laparoscopy.Methods:Between August 2009 and May 2011,a single urologist in our center performed 13 cases of transperitoneal LESS adrenalectomy through a 2-3 cm skin incision using the TriPort access system and 26 cases of standard laparoscopic adrenalectomy.The clinical and follow-up data were statistically analyzed.Results:The 2 groups were compared with respect to patient demographics,estimated blood loss,and postoperative hospitalization(P>0.05).The LESS procedures had a longer mean operative time(148.5:112.9 mins,P =0.032),but a significantly lower postoperative visual analog pain scale score(2.3:3.7,P = 0.001).fewer patients requiring analgesics(30.8%:73.1%.P = 0.011),and an earlier resumption of oral intake(21.6:26.0 hours.P = 0.002).The mean length of the scar in the LESS group was much smaller(2.3:5.9 cm.P<0.001) with a statistically significant greater mean cosmetic satisfaction score(9.5:9.1.P = 0.042).Conclusions:The transperitoneal LESS adrenalectomy provides better postoperative pain control,faster recovery of bowel function,and better cosmetic satisfaction than standard laparoscopy. albeit with a longer operative time.It is a feasible,safe,and effective option for small adrenal tumors.