经脐单孔腹腔镜与标准三孔后腹腔镜肾上腺切除术的疗效比较

A comparative study of embryonic natural orifice transumbilical endoscopic surgery(E-NOTES)versus standard laparoscopic adrenalectomy for benign adrenal tumors

目的对比12例经脐单孔腹腔镜(E-NOTES)和23例标准三孔后腹腔镜肾上腺肿瘤切除术,评价E-NOTES肾上腺切除术的实用性、安全性及疗效。方法 2008年6月至2012年6月天津医科大学第二医院手术治疗的肾上腺良性肿瘤35例,其中E-NOTES肾上腺切除术12例,标准三孔后腹腔镜肾上腺切除术23例。所有手术均为同一术者完成。对两种术式的手术时间、术中平均出血量、术后胃肠道功能恢复时间(以排气为标准)、术后住院天数、并发症发生率、手术总费用等进行比较并进行统计学分析。结果 E-NOTES肾上腺手术12例全部成功,标准三孔组1例因损伤肾静脉转开放手术,其余22例均顺利完成。两组在性别、年龄、肿瘤大小、功能性腺瘤所占比例及术后胃肠功能恢复时间方面差别无统计学意义。单孔组平均手术时间比标准组较长(分别为98.75 min和80.87 min,P=0.02),但术中平均出血量较少(分别为35.00 ml和64.34 ml,P=0.01),术后住院天数较短(分别为3.75 d和5.21 d,P=0.02),手术费用较低(分别为12444.70元和14624.42元,P=0.001)。结论 E-NOTES肾上腺肿物切除术安全有效,尽管手术时间较长,但在术中平均出血量、术后住院天数、术中及术后并发症发生率、手术总费用方面优于标准三孔手术。

Objective To assess the feasibility, safety, and efficacy of embryonic natural orifice transumbilical endoscopic surgery （E-NOTES） adrenalectomy through a comparative study of 12 patients with E-NOTES and 23 patients with standard laparoscopic adrenalectomy. Methods From June 2008 to June 2012, 35 patients with benign adrenal tumors underwent the surgical treatment in the Second Hospital of Tianjin Medical University, of which 12 cases were performed by E-NOTES. This cohort was compared with a contemporary group of 23 patients underwent standard laparoscopic adrenalectomy by the same urologist. The perioperative outcomes, including mean operative time, estimated blood loss, recovery of bowel function, postoperative hospital stay, total cost of surgery, peri- and postoperative complications were analyzed. Results The E-NOTES group were completely sucessful with no laparoscopic or open conversion, while the matched group had one conversion to open surgery due to the injury of renal vein. The two groups didn＇t show statistical significance in gender, age, tumor size, diagnosis and recovery of bowel function. The E-NOTES procedures had a longer mean operative time （98.75 minutes vs 80.87 minutes, P=0.02）, but a significantly less estimated blood loss （35.00 ml vs 64.34 ml, P=0.01）, a shorter postoperative hospital stay （3.75 d vs 5.21 d, P=O.02） and a lower total cost of surgery （12444.70 yuan vs 14624.42 yuan, P=0.001）. Conclusion The E-NOTE adrenalectomy is as safe and effective as standard adrenalectomy for benign adrenal tumors. In addition, The E-NOTES provides advantages of less estimated blood loss, shorter postoperative hospital stay, less total cost of surgery, fewer peri- and postoperative complications.