后腹腔镜与腹腔镜肾上腺肿瘤切除术的评价

Retroperitoneal and transperitoneal laparoscopic adrenalectomy for adrenal tumors

目的 评价后腹腔镜及腹腔镜行肾上腺肿瘤切除术的临床价值。 方法 回顾性分析自 1996年 1月～ 1999年 8月经后腹腔镜肾上腺肿瘤切除术 8例 (A组 )及经腹腔腹腔镜肾上腺肿瘤切除术 12例 (B组 )的临床资料 ,并就二组手术时间、术中出血量、术后肠功能恢复情况及平均住院日等指标进行比较。 结果 切除肿瘤平均重量A组 >B组 ,而平均手术时间和术中平均出血量A组比B组分别缩短 2 3min和减少 15 .8ml,术后肠功能平均恢复时间和术后平均住院日A组比B组分别提前 0 .2 5天和减少 1.6天。但二组各项指标结果比较差别无显著性意义 (P >0 .0 5 )。 结论 腹腔镜肾上腺肿瘤切除术经后腹腔途径优于经腹腔途径。除肿瘤直径 >6cm、伴有心脑损害及位于肝后方或下腔静脉后方的嗜铬细胞瘤、体胖的皮质醇腺瘤外 ,均为腹腔镜手术适应证。

Objective To evaluate retroperitoneal and transperitoneal laparoscopic adrenalectomy for adrenal tumors. Methods From Jan. 1996 to Aug.1999, retroperitoneal laparoscopic adrenalectomy was carried out for 8 cases of adrenal tumors and transperitoneal laparoscopic adrenalectomy for 12 patients.The procedures were evaluated and a comparative study was made between the two groups. Results The laparoscopic procedures have been successful in all.The mean operation time via the retroperitoneal and the transperitoneal route was 153 vs 176 minutes,the blood loss 188 vs 204ml,the recovery time of GI function 1.51 vs 1.76 days and the hospital stay 9.4 vs 11 days.The retroperitoneal route seemed to be better.However,the difference was statistically insignificant. Conclusions Laparoscopic adrenalectomy is feasible for the treatment of adrenal tumors.The retroperitoneal approach seems to be better.For tumors over 6 cm in diameter and pheochromocytoma with cardiac and brain complications or located behind the liver or inferior vena cava,laparoscopic adrenalectomy is not indicated.