两种入路腹腔镜肾上腺嗜铬细胞瘤切除术的临床应用

Clinical application of laparoscopic adrenal pheochromocytoma resection in two different operative approaches

目的:评估两种入路在腹腔镜嗜铬细胞瘤手术中的临床应用价值及对血流动力学的影响。方法:选择72例肾上腺嗜铬细胞瘤患者,随机分为经腹组(n=36)与腹膜后组(n=36),对比术中、术后指标,评估血流动力学变化。结果:腹膜后组手术时间、术中出血量、下床活动时间、术后疼痛评分、引流管留置时间、术后住院时间、切口满意度评分均优于经腹组(P<0.05)。对瘤体进行操作时两组患者收缩压、舒张压均有升高趋势,收缩压在游离肿瘤1 min、肿瘤游离完成、手术操作结束时腹膜后组低于经腹组(P<0.05)。舒张压、心率在游离肿瘤1 min、肿瘤游离完成时腹膜后组低于经腹组(P<0.05)。结论:经腹膜后入路行腹腔镜肾上腺嗜铬细胞瘤切除术手术时间短,出血少,患者康复快,对血流动力学稳定性影响小,可作为腹腔镜肾上腺嗜铬细胞瘤切除术的优先选择入路。

Objective： To evaluate the clinical value and hemodynamic change between two operative approaches in laparoscopic adrenal pheochromocytoma resection. Methods： Seventy-two patients diagnosed as adrenal pheochromocytoma were selected and randomly divided into transabdominal group（ n = 36） and retroperitoneal group（ n = 36）. Clinical indicators in operation and after operation were compared and hemodynamic indexes were evaluated. Results： Compared with transabdominal group,the operating time,intraoperative bleeding,ambulation time,postoperative pain score,drainage time and hospital stay were less and incision satisfaction score was higher in retroperitoneal group（ P〈0. 05）. Systolic blood pressure and diastolic blood pressure were increased in both groups when tumor was operated,systolic blood pressure in retroperitoneal group was lower when the dissociation of tumor lasted one minute,finished,and when the operation was finished than that in transabdominal group（ P〈0. 05）. Diastolic blood pressure and heart rate in retroperitoneal group was lower when the dissociation of tumor lasted one minute and finished than that in transabdominal group（ P〈0. 05）. Conclusions： Retroperitoneal approach in laparoscopic adrenal pheochromocytoma resection can be a prior choice with the advantage of shorter operation time,less bleeding,faster recovery and more stable hemodynamics.