腹腔镜右肾上腺切除术:经腹与经腹膜后入路的比较

Laparoscopic Right Adrenalectomy: A Comparison of Transperitoneal Approach and Retroperitoneal Approach

目的比较经腹腔与经腹膜后入路行腹腔镜解剖性右肾上腺切除术的临床效果。方法2011年1月至2016年12月于本科室行腹腔镜解剖性右肾上腺切除术患者252例,经腹腔入路139例,经后腹腔入路113例,比较两种入路的手术时间、术中出血量、中转开放率、术中并发症、术后镇痛药物应用及术后进食时间。按肿瘤大小将该组资料分为病变大小≥5cm和病变大小<5cm两个亚组,分别比较各亚组中两种入路的手术指标。结果经腹腔入路组平均手术时间(86.44分钟)显著低于经腹膜后入路组(107.43分钟)(P<0.01),平均出血量(47.32ml)显著少于经腹膜后入路组(75.49ml)(P<0.01),但在病变大小≥5cm的亚组中,两种手术入路无统计学差异。结论腹腔镜右肾上腺切除术经腹腔入路具有手术时间短、出血量少的优势,但对于病变大小≥5cm,无明显优势。

Objective To compare the transperitoneal approach and the retroperitoneal approach for laparoscopic right adrenalectomy. Methods From January 2011 to December 2016,252 patients underwent laparoscopic right adrenalectomy in our department. One hundred and thirty nine patients were performed through transperitoneal approach and 113 patients through retroperitoneal approach. The operation time,blood loss,conversion rate,complication rate,use of analgesic drug and time to oral intake were recorded and compared between these two approaches. According to the tumor size,the patients were divided into subgroups of tumor ≥5 cm and tumor 5 cm. The two approaches were compared in each subgroup. Results In general,the average operative time of transperitoneal approach（ 86. 44 minutes） is significantly shorter than that of the retroperitoneal approach（ 107. 43 minutes）（ P 〈0. 01）. The average blood loss of transperitoneal approach（ 47. 32 ml） is significantly less than that of the retroperitoneal approach（ 75. 49 ml）（ P 〈0. 01）. However,in the subgroup of tumor ≥5 cm,no statistical difference was found between these two approaches. Conclusions Transperitoneal approach is associated with shorter operative time and less blood loss for laparoscopic right adrenalectomy. For tumor ≥5 cm,there is no advantage for transperitoneal approach.