两种腹腔镜肾上腺切除术对肾上腺肿瘤患者的疗效比较

The comparison of efficacy between two different LA procedures in the treatment of patients with adrenal tumors

目的比较两种不同腹腔镜肾上腺切除术(LA)对肾上腺肿瘤(AT)患者的疗效。方法 98例行LA治疗的AT患者,其中经腹腔入路40例(TLA组),经腹膜后入路58例(RLA组),比较两组围术期指标及术前术后氧化应激水平、肾功能、免疫功能的变化。结果 RLA组手术时间、术中出血量、术后镇痛药物使用量、胃肠道功能恢复时间及住院时间均少于TLA组(P <0. 05);两组中转开放手术率及术后并发症发生率比较,差异无统计学意义(P> 0. 05); RLA组术后3天血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、血清免疫球蛋白Ig G水平高于TLA组,血清丙二醛(MDA)水平低于TLA组(P <0. 05);两组术后3天血清尿素氮(BUN)、肌酐(s Cr)、β2-微球蛋白(β2-MG)、血清Ig A、Ig M水平比较,差异无统计学意义(P> 0. 05)。结论 RLA具有术中出血量少、手术时间短、术后胃肠道功能恢复快、氧化应激反应较轻等优点,且对患者肾功能及免疫功能影响较小。

Objective To compare the efficacy of two different laparoscopic adrenalectomy(L A)in the treatment of patients with adrenal tumors(A T).Methods The clinical data of 98 AT patients who underwent LA were retrospectively analyzed.Of these patients,cases were given transperitoneal approach(TLA group)and 58 cases were given retroperitoneal approach(RLA group).The perioperative indexes,oxidative stress levels,renal function and immune function before and after operation were compared between the two groups.Results The operative time,intraoperative blood loss,postoperative analgesic drug use,recovery time of gastrointestinal function and hospital stay in the RLA group were all shorter or lower than those in the TLA group(P<0.05).There was no significant difference in the rate of conversions to open surgery and the incidence of postoperative complications between the two groups(P>0.05).The levels of serum superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)in the RLA group at the 3rd day after operation were higher than those in the TLA group(P<0.05)while serum malondialdehyde(MDA)level was lower than that in the TLA group(P<0.05).There was no significant difference in the levels of serum urea nitrogen(B U N),creatinine(sCr)and β2-microglobulin(β2-M G)between the two groups at the 3rd day after operation(P>0.05).The serum immunoglobulin IgG level in the RLA group was significantly higher than that in the TLA group(P<0.05).There was no significant difference in serum IgA and IgM levels between the two groups(P>0.05).Conclusion RLA has advantages of little intraoperative blood loss,short operative time,fast recovery of postoperative gastrointestinal function and mild oxidative stress response.It also has small effects on renal function and immune function.