后腹腔镜小儿肾上腺肿瘤切除术与开放手术的比较

Comparative Study on Retroperitoneal Laparoscopic Adrenalectomy and Open Adrenalectomy in Children with Adrenal Tumors

目的比较后腹腔镜与开放手术治疗小儿肾上腺肿瘤的临床疗效和随访结果。方法回顾分析我院2002年6月-2009年3月38例行后腹腔镜肾上腺手术和32例开放肾上腺手术治疗小儿肾上腺肿瘤患者的临床资料,对两组的临床疗效及随访结果等进行对比分析。结果两组在发病年龄、肿瘤大小、手术时间比较差异无统计学意义;两组平均术中出血量、术后肠功能恢复时间、术后止痛药的应用及术后住院天数分别为:(95.4±32.0)ml和(155.3±41.7)ml;(1.5±0.4)d和(2.8±1.5)d;21.1%和50%;(5.5±0.8)d和(8.5±2.1)d,两组比较差异有统计学意义(P<0.05)。后腹腔镜组术后并发症少于开放组。两组病例的5年无复发生存率及5年生存率比较差异无统计学意义。结论后腹腔镜小儿肾上腺肿瘤切除术与开放手术相比,疗效相当,创伤小、痛苦少、术后恢复快、并发症少,可作为小儿肾上腺肿瘤切除的首选治疗方法。

Objective To compare the clinical outcomes and the follow up of retroperitoneal laparoscopic adrenalectomy and open adrenalectomy for the treatmnent of adrenal tumors in children. Methods The clinical data of 38 children underwent retroperitoneal laparoscopic adrenalectomy and 32 children underwent open adrenalectomy from June, 2002 to March, 2009 were analyzed retrospectively. The therapeutic effects and the follow - up data of the two groups were compared. Results No statistically significant difference was found in age, tumor size, and average operating time between the two groups. The intraoperative bleeding loss（95.4± 32.0 ml）, the mean time to oral intake （ 1. 5± 0.4 d）, use of analgesic （21. 1 % ）, duration of postoprative hospital stay （5.5±0.8 d） and incidence of complications with group A were significantly superior to those（155.3±41.7 ml）, （2.8± 1.5 d）, （50%）, （8.5 ±2.1 d） with group B （P〈0.05）. There was no statistically significant difference in the .5 year recurrence free survival rate and the 5 - year overall survival rate between the two groups. Conclusions As compared with open adrenalectomy, retroperitoneal laparoscopic adrenalectomy can be used initially for adrenal tumors in children, with equivalent oncologic outcomes to open approaches while providing advantages of minimal invasion, less suffering, quicker recovery and less complication.