经腹腹腔镜再次肾上腺肿瘤切除术可行性分析

Transperitoneal laparoscopic adrenalectomy:a feasible procedure for patients with prior ipsilateral retroperitoneal laparoscopic adrenalectomy history

目的探讨经后腹腔镜肾上腺肿瘤切除术后原位复发患者,行经腹腹腔镜肾上腺肿瘤切除术的可行性和安全性。方法回顾性分析2013年1月至2015年6月本中心收治的肾上腺肿瘤原位复发患者23例的临床资料,23例中再次行开放手术14例,行腹腔镜手术9例。比较两种术式术中及围术期评价指标,包括手术时间、术中失血量、术中输血量、术后禁食时间、下床活动时间、术后住院时间等,以及术中和术后并发症的发生率,包括气胸、皮下气肿、血管损伤、脏器损伤、下肢深静脉血栓等。结果两种术式的手术时间、术中输血量和术后禁食时间比较,差异均无统计学意义（P均〉0.05）。与开放手术相比,腹腔镜手术术中失血量少（P〈0.05）,术后下床活动时间早（P〈0.05）,术后住院时间短（P〈0.05）。两组患者均未出现严重术中及术后并发症,随访13~37个月,无死亡病例。结论对于经后腹腔镜肾上腺肿瘤切除术后原位复发的患者,与开放手术相比,再次经腹腔腹腔镜肾上腺肿瘤切除术是一种安全可行的手术方式,有利于减少术中出血,加快患者术后康复。

Objective To determine whether transperitoneal laparoscopic adrenalectomy procedure is feasible for patients with previous ipsilateral retroperitoneal laparoscopic adrenalectomy history. Methods Twenty-three patients with prior ipsilateral retroperitoneal laparoscopic adrenalectomy underwent open or transperitoneal laparoscopic approaches were enrolled, including 14 cases of open and 9 cases of transperitoneal laparoscopic. Perioperation parameters, such as operative time, estimated blood loss, intra-operation blood transfusion, time to first oral intake, time to ambulation, postoperative hospital stay, and open conversion rate were assessed retrospectively. Postoperation complications including pneumothorax, vascular injury, visceral injury, respiratory infection, inci- sion infection, incision hernia, hematoma, deep venous thrombosis and postoperative ileus were e- valuated afterward. Results No statistically significant differences in operation time, intra- and post-operation blood transfusion, or time to first oral intake were noted between open and laparoscopic groups （all P 〈0.05）. However, laparoscopic surgery showed more preferable outcomes as measured by the estimated blood lose, time to ambulation and postoperative hospital stay （all P 〉0.05）. There was no major operative morbidities noted in either group. Intraand post-operative complication rates were statistically similar in these subgroups after 13 to 37 months of follow-up （P 〉0.05）. Conclusions The transperitoneal laparoscopic adrenalectomy could be safely and effectively performed in patients with extensive prior retroperitoneal surgical history without increasing operative risks and complications.