后腹腔镜肾上腺疾病术中并发症的预防及处理

Prophylaxis and Management of Intraoperative Complications of Retroperitoneal Laparoscopic Adrenalectomy

目的探讨后腹腔镜肾上腺疾病术中并发症的预防及处理。方法选取2013年1月至2017年12月我院治疗肾上腺疾病120例患者作为研究对象,观察手术指征与并发症,分析手术并发症与肿瘤直径大小的相关性。结果全部患者皆采用后腹腔镜下肾上腺切除术,手术时间30～180分钟,平均(44. 8±5. 9)分钟,术中出血量10～400ml,平均(25. 2±5. 7) ml,术后禁食1～4d,平均(1. 2±0. 6) d,术后引流管拔出时间2～7d,平均(3. 0±0. 5) d,术后住院时间5～12d,平均(5. 8±2. 7) d。全部患者皆顺利出院,术中并发症42例,其中腹膜损伤12(10. 00%)例,皮下气肿11(9. 17%)例,出血8(6. 67%)例,膈肌损伤5(4. 17%)例,肾脏损伤4(3. 33%)例,术中由于出血而输血者2(1. 67%)例;其中有7例由于出血或脏器侵害转开放性手术。肿瘤直径大小与并发症出血、肾脏损伤、侧别呈现正相关性(P <0. 05);腹膜损伤、皮下气肿与直径大小无显著相关性(P> 0. 05)。结论肾上腺疾病经后腹腔镜入路手术治疗效果佳,同时完全掌握肾上腺解剖结构与成熟的腹腔镜技术可降低并发症发生率。

Objective To investigate the prophylaxis and management of intraoperative complications of retroperitoneal laparoscopic adrenalectomy.Methods 120 patients with adrenal diseases enrolled in our hospital from January 2013 to December 2017 were selected,and their surgical indications and complications were observed.The correlation between surgical complications and tumor diameter was analyzed.Results All patients underwent retroperitoneal laparoscopic adrenalectomy;The operation time was 30~180 minutes,with an average of(44.8±5.9)minutes.The intraoperative blood loss was10~400 ml,with an average of(25.2±5.7)ml.The fasting lasted for 1~4 days,with an average of(1.2±0.6)days,The time of postoperative drainage tube extraction was 2~7 d,with an average of(3.0±0.5)d.The postoperative hospital stay was 5~12 d,with an average of(5.8±2.7)d.A total of 42 cases of intraoperative complications occurred,including 12 cases(10.00%)of peritoneal injury,11 cases(9.17%)of subcutaneous emphysema,8 cases(6.67%)of hemorrhage,5 cases(4.17%)of diaphragmatic injury,and 4 cases(3.33%)of kidney injury;2 cases(1.67%)received blood transfusion due to intraoperative blood loss;7 cases converted to open surgery due to bleeding or organ damage.There was a positive correlation between tumor diameter and complications,renal injury as well as side(P<0.05).There was no significant correlation between peritoneal injury&subcutaneous emphysema and diameter(P>0.05).Conclusion The retroperitoneal laparoscopic adrenalectomy presents satisfactory effect for patients with adrenal disease,moreover,the full mastery of adrenal anatomical structure and skilled laparoscopic technique can prevent the occurrence of complications.