经肾上腺腹侧间隙行后腹腔镜肾上腺肿瘤切除术的临床体会(附30例报告)

Clinical experience of retroperitoneal laparoscopic adrenalectomy through ventral anatomic space of adrenal gland:with a report of 30 cases

目的:探讨经肾上腺腹侧间隙行后腹腔镜肾上腺肿瘤切除术的临床优势。方法:30例患者经肾上腺腹侧间隙行后腹腔镜肾上腺肿瘤切除术(改良组),20例患者行传统解剖性后腹腔镜肾上腺肿瘤切除术(传统组),术前均诊断明确,患者平均(46.5±3.8)岁,瘤体直径平均(3.2±0.6)cm。比较两组患者手术时间、术中失血量、术后引流管放置时间、住院时间等指标。结果:30例后腹腔镜改良术式均获成功,手术时间30~70 min,平均(40.5±18.25)min;术中失血10~30 ml,平均(15.6±6.6)ml;术后引流管留置1~2 d,平均(1.9±0.2)d,平均住院(4.7±0.6)d;均优于传统组,差异有统计学意义(P<0.05)。结论:经肾上腺腹侧间隙行后腹腔镜肾上腺肿瘤切除术创伤更小,出血更少,手术时间、住院时间缩短,术后患者康复快,值得推广。

Objective： To study the ascendancy of the modified retroperitoneal laparoscopic adrenalectomy through ventral anatomic space of adrenal gland. Methods： Thirty patients of adrenal tumor were treated by retroperitoneal laparoscopic adrenalectomy with modified methods,and 20 cases were treated with traditional methods. The average age of the patients was（ 46. 5 ± 3. 8） years old and the average diameter of the tumor was（ 3. 2 ± 0. 6） cm. Operation time,intraoperative blood loss,postoperative drainage tube placement time,and average duration of hospitalization of the two groups were compared. Results： Thirty cases treated by modified methods all succeeded and no complications were found. Operation time was（ 40. 5 ± 18. 25） min（ range,30-70 min） and intraoperative blood loss was（ 15. 6 ± 6. 6） ml（ range,10-30 ml）. Drainage tube was retained for（ 1. 9 ± 0. 2） d（ range,1-2 d）,and average hospital stay was（ 4. 7 ± 0. 6） d. Compared with those of traditional laparoscopic adrenalectomy,all above indices were better（ P〈0. 05）. Conclusions：Retroperitoneal laparoscopic adrenalectomy performed by modified methods for the treatment of adrenal tumor has advantages over traditional methods,such as less trauma,less bleeding,shorter operative time,shorter hospital stay and quicker postoperative recovery. It deserves to be recommended in the clinical application.