经腹腔和经后腹膜腔途径腹腔镜手术治疗肾上腺肿瘤的对比研究

Comparison of transperitoneal versus retroperitoneal approach in laparoscopic adrenalectomy for adrenal tumor

目的比较经腹腔途径和经后腹膜腔途径两种腹腔镜手术在肾上腺肿瘤治疗中的应用及对机体应激的影响。方法 2001年12月至2009年2月我们应用腹腔镜手术治疗肾上腺肿瘤110例,其中34例采用经腹腔途径,76例采用后腹膜腔途径,两组患者年龄、性别构成、体重指数、肿瘤大小等指标无明显差别;采用化学发光法检测术前24h、术中切除瘤体时及术后24h血清肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、C反应蛋白(CRP)和血清淀粉样蛋白A(SAA)水平。结果 110例手术全部成功,手术时间30～250min,其中经腹腔途径160±30min(80～250min),经后腹腔途径60±14min(30～180min),两组差别具有统计学意义(t=2.33,P=0.006);术中出血10～150ml,其中经腹腔途径组80±24m(l40～150ml),后腹膜腔途径组20±7ml(10～90ml),两组差别具有统计学意义(t=3.19,P=0.02),所有患者均未输血。110例患者术后平均住院3～14d,其中经腹腔途径组7±2d,后腹膜腔途径组5±1d,差别无统计学意义(t=1.06,P=0.17)。两组患者术前24h、术中切除瘤体时及术后24h血清TNF-α,IL-6,CRP和SAA水平差别均无统计学意义(P>0.05)。结论腹腔镜手术治疗肾上腺肿瘤,具有创伤小,康复快,安全可靠的优点。后腹膜腔途径相对腹腔途径术中出血更少,手术时间更短。

Objective To evaluate and compare the effect and surgical stress response of laparo- scopic adrenaleetomy with retroperitoneal and transperitoneal approach. Methods The clinical data of 110 cases received laparoscopic adrenalectomy （retroperitoneal approach, n=76; transperitoneal approach, n= 34） were compared. There were no significant differences in age, sex, body mass index, and tumor volume between these two groups. The operation time, average bleeding volume during operation, hospitalization stay after operation and occurrence of postoperative complication of the two procedures were compared. Serum levels of TNF-α, IL-6, CRP and SAA were measured using chemiluminescent immunometric tests. Results All the adrenalectomies were successful. The mean operating time was 160-30 minutes （80-250 min）, and 60-14 minutes （30-180 min） for transperitoneal laparoscopic adrenoectomy, and retroperitoneal laparoscopic adrenaleetomy respectively （t=2.33, P=0.006）. The average bleeding volume during operation being 80±24ml （40-150 ml）, and 20±7 ml （10-90 ml） respectively （t=3.19, P=0.02）, and the mean postop- eration hospitalization was 7 days, and 5 days respectively （P〉0.05）. There were no significant differences between the two groups in serum levels of TNF-α, IL-6, CRP and SAA before and after surgery. Conclusions Laparoseopic adrenalectomy has the advantages of mini-incision, less trauma to patients, less blood loss and quicker recovery. Especially, the retroperitoneal approach was better than the transperitoneal approach in surgical bleeding and duration.