腹腔镜下两种入路切除巨大肾上腺肿瘤的安全性和可行性比较

Comparison of the safety and feasibility of two laparoscopic approaches for resection of giant adrenal tumors

目的比较腹腔镜下经腹腔入路和腹膜后入路切除巨大肾上腺肿瘤的安全性和可行性,评价其手术效果。方法回顾性分析郑州大学附属洛阳中心医院在2010-10~2017-05期间收治的87例巨大肾上腺肿瘤患者的手术治疗资料,其中行经腹腔入路肾上腺切除术47例,行腹膜后入路肾上腺切除术40例,比较两种方法的手术时间、术中失血量、术后进食恢复时间及术后住院时间等。结果87例手术均顺利完成,均无明显手术并发症。经腹腔入路手术时间较腹膜后入路短,术中失血量较经腹膜后入路少(P<0.05);经腹膜后途径患者术后进食恢复时间、术后住院时间较经腹腔途径患者短(P<0.05)。结论两种入路均可切除肾上腺肿瘤,应根据病变性质、肿瘤大小、位置及患者的具体情况选择手术入路。

Objective To compare the safety and feasibility of transperitoneal and retroperitoneal approaches for laparoscopic resection of giant adrenal tumors,and to evaluate the effect of the operations.Methods Eighty-seven patients with giant adrenal tumors were collected in Luoyang Central Hospital Affiliated to Zhengzhou University from October 2010 to May 2017 and their surgical data were retrospectively analyzed among whom transperitoneal adrenalectomy was performed in 47 cases and anatomic adrenalectomy by retroperitoneal laparoscopy was performed in 40 cases.The operation time,intraoperative blood loss,postoperative feeding recovery time and postoperative hospital stay were compared between the two operation methods.Results All the operations of the 87 cases were successfully completed without obvious complications.The operation time of the transperitoneal approach was significantly shorter than that of the retroperitoneal approach(P<0.05).The intraoperative blood loss in the patients treated with the transperitoneal approach was significantly less than that in the patients treated with the rettoperitoneal approach(P<0.05).The time of postoperative feeding recovery and postoperative hospital stay in the patients with retroperitoneal approach significantly shorter than that in the patients treated with the transperitoneal approach(P<0.05).Conclusion Both approaches can be used to resect adrenal tumors,and the surgical approaches should be selected according to the nature of the lesion,tumor size,location and the patients′specific conditions.