腹腔镜左肾上腺切除术:经腹与经腹膜后入路的比较

Laparoscopic Left Adrenalectomy: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左肾上腺切除术的效果。方法回顾性分析2011年1月～2016年12月腹腔镜解剖性左肾上腺切除术242例资料,经腹腔入路132例,经腹膜后入路110例,按肿瘤长径<5 cm和≥5 cm分为2个亚组,分别比较手术时间、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排气时间。结果肿瘤长径<5 cm的亚组中,相比经腹膜后入路,经腹腔入路手术时间短[中位数90(35～170)min vs.95(50～220)min,Z=-2.141,P=0.032],出血量少[30(10～300)ml vs.60(20～800)ml,Z=-7.504,P=0.000],但术后排气晚[2(1～5)d vs.2(1～5)d,Z=-4.616,P=0.000],其余观察指标无统计学差异;肿瘤长径≥5 cm的亚组中,2种入路术中及术后指标均无统计学差异。结论腹腔镜左肾上腺切除术,肿瘤长径<5 cm时经腹腔入路手术时间较短,出血量较少,经腹膜后入路术后肠道功能恢复较快;肿瘤长径≥5 cm时2种手术入路无显著差异。

Objective To compare transperitoneal approach and retroperitoneal approach for laparoscopic left adrenalectomy. Methods From January 2011 to December 2016, 242 patients underwent laparoscopic left adrenalectomy in our department. A total of 132 patients were given transperitoneal approach operations and 110 patients retroperitoneal approach. According to tumor diameter, the patients were divided into subgroups of tumor ≥ 5 cm or 〈 5 cm. The operative time, blood loss, conversion rate, complication rate, use of analgesic drug and exhaust time were compared between the two approaches in each subgroup. Results In the subgroup of tumor 〈 5 cm, as compared with the retroperitoneal approach, the transperitoneal approach was associated with shorter operative time [median：90 （35 -170） min vs. 95 （50 -220） min, Z = -2. 141, P =0.032], less blood loss [30 （10 -300） ml vs. 60 （20-800） ml, Z= -7.504, P=0.0001, and longer exhaust time [2 （1 -5） dvs. 2 （1 -5） d, Z= -4.616, P=0.000]. In the subgroup of tumor ≥5 cm, no statistical difference was found between the two approaches. Conclusions For tumor 〈 5 cm, transperitoneal approach is associated with shorter operative time and less blood loss. Retroperitoneal approach is associated with faster recovery of bowel function. However, for tumor ≥5 cm, there is no statistical difference between the two approaches.