腹腔镜与开放手术治疗肾上腺疾病的疗效比较

A comparative study of laparoscopic and open adrenalectomy

目的评价腹腔镜手术治疗肾上腺疾病的临床价值。方法回顾性分析比较160例腹腔镜手术和52例开放手术治疗肾上腺疾病患者临床疗效。结果腹腔镜组除转开放手术4例(2.50%),余均成功。腹腔镜手术和开放手术两组手术时间分别为(115.03±48.67)min和(131.44±73.63)min,术中出血量分别为(101.51±107.80)ml和(358.05±401.80)ml,术后住院天数分别为(4.50±1.90)d和(9.81±3.93)d,其后两项组间差异均有统计学意义(t分别=-7.28、-12.96,P均<0.05)。腹腔镜组手术后并发症4例,开放组5例。随访2月～7.5年,平均(14.94±5.82个月),腹腔镜组和开放组低血钾改善率分别为91.43%和83.33%,高血压改善率分别为54.26%和58.33%,两组差异均无统计学意义(χ2分别=0.87、0.13,P均>0.05)。结论与开放手术相比,腹腔镜手术具有创伤小、出血少、切口美观、病人恢复快等优点,可作为肾上腺疾病的首选治疗方法之一。

Objective To evaluate clinical application of laparoscopic adrenalectomy for adrenal diseases. Methods Clinical data of the patients undergoing laparoscopic adrenalectomy （LA, n = 160） and open adrenalectomy （OA, n = 52） were retrospectively analyzed. Results There were 4 cases of open conversion （ 2.5 % ）. The operation time were （ 115.03 ± 48.67） rain and （ 131.44 ± 73.63） rain in the LA and OA group, respectively（ P 〉 0.05） .The blood loss during operation was （ 101.51 ± 107.80） ml vs. （358.05 ±401.80） ml（ t = - 7.28, P 〈 0.05）, and postoperative hospitalization was （4.50 ± 1.90） daysvs. （9.81 ± 3.93 ）days, respectively（ t = - 12.96 ,P 〈 0.05）. Therewere 4and 5cases ofcomplicationinLA and OA group, respectively. The mean follow - up was （ 14.94 ± 5.82） months（range 2 - 90 months）, and there was no statistics difference between the two groups in terms of hypokalemia and hypertension improvement. Conclusion Compared with open adrenalectomy, laparoscopic adrenalectomy has advantages of minimal morbidity, small incision, less bleeding and rapid recovery. This method could be considered as the first option in the treatment of adrenal diseases.