腹腔镜与开放手术治疗肾上腺嗜铬细胞瘤的疗效比较

Comparison of therapeutic effect of laparoscope and open operation in treatment of adrenal pheochromocytoma

目的 比较腹腔镜与开放手术治疗肾上腺嗜铬细胞瘤的临床疗效。方法 52例肾上腺嗜铬细胞瘤患者采用数字表法随机分为两组,分别给予腹腔镜与开放手术治疗,比较两组术中出血量、术中血压及心率波动情况、手术时间、引流量、术后并发症发生情况及住院时间等。结果 术中比较：腹腔镜组术中出血量为（65.7±50.2）ml、血压波动例数为1例（3.8%）、心率波动大小为（18.7±6.1）次/min及手术时间为（93.7±21.7）min,开放手术组术中出血量为（240.4±150.5）ml、血压波动例数为7例（26.9%）、心率波动大小为（25.6±6.3）次/min及手术时间为（137.7±30.5）min,两组差异均有统计学意义（t=3.15,χ^2=5.32,t=3.65,t=4.16,均P＜0.05）;开放手术组治疗最大肿瘤直径为（7.3±1.4）cm,大于腹腔镜组的（6.6±1.2）cm,但两组差异无统计学意义（P＞0.05）。术后比较：腹腔镜组术后引流量（174.3±121.3）ml、引流时间（4.3±1.3）d及住院时间（8.4±1.2）d均明显少于开放手术组的（318.5±132.6）ml、（8.7±2.3）d及（11.4±3.2）d（t=2.54、3.13、2.12,均P＜0.05）。两组均未见严重并发症发生,腹腔镜组有1例、开放组有5例患者出现术后疼痛,给予相应的对症治疗后好转;随访3个月后临床症状均有明显改善或消失,复查彩超或CT未发现有复发。结论 肾上腺嗜铬细胞瘤采用腹腔镜治疗不仅疗效确切,且创伤小、手术时间短、并发症少,值得临床推广应用。

Objective To compare the clinical efficacy of laparoscope and open operation in treatment of adrenal pheochromocytoma.Methods 52 cases with adrenal pheochromocytoma were randomly divided into two groups,they were treated with laparoscope or open operation.Intraoperative blood loss,intraoperative blood pressure and heart rate fluctuations,operation time,drainage,hospitalization and postoperative complications were compared between two groups.Results Intraoperative comparison： In laparoscope group,operative blood loss was （65.7±50.2）ml,blood pressure fluctuations in 1 case（3.8%）,heart rate variability was （18.7±6.1）/min and the operation time was （93.7±21.7）min;in the open operation group,amount of bleeding during the operation was （240.4±150.5）ml,blood pressure fluctuations in 7 cases（26.9%）,heart rate variability was （25.6±6.3）/min and the operation time was （137.7±30.5）min,the differences between the two groups was significant （t=3.15,χ2=5.32,t=3.65,t=4.16,all P〈0.05）.The maximum tumor diameter of open operation group was （7.3±1.4）cm,which was bigger than that of the laparoscope group（6.6±1.2）cm,but no significant difference between two groups（P〉0.05）.Postoperative comparison： in the laparoscope group,postoperative drainage was （174.3±121.3）ml,drainage time was （4.3±1.3）d and time of hospitalization was （8.4±1.2）d,which were significantly less than those in open operation group（318.5±132.6）ml,（8.7±2.3）d and （11.4±3.2）d（t=2.54 3.13,2.12,all P〈0.05）.No serious complications were observed in two groups,laparoscope group 1 case,open operation group 5 cases had postoperative pain,after the corresponding symptomatic treatment was improved.After 3 months of follow-up,clinical symptoms were significantly improved or disappeared,ultrasound or CT reexamination found no recurrence.Conclusion Laparoscope in treatment of adrenal pheochromocytoma not only has definite curative effect,but also has small trauma,shorter operation time and less complications,it is worth clinical application.