经腹和经腹膜后肾周脂肪外平面入路肾上腺切除术的比较

Clinical comparison of laparoscopic adrenalectomy by external plane of perirenal fat: transperitoneal versus retroperitoneal approach

目的探讨肾周脂肪外平面入路肾上腺切除术的手术技巧及临床效果。方法回顾分析2018年1月至2018年12月中山大学附属第三医院及南方科技大学医院双中心多治疗组经治的肾上腺肿瘤切除患者136例。其中经腹腔肾周脂肪外平面入路97例,经腹膜后平面入路39例,比较患者术中及术后情况。结果136例均手术成功,经腹腔肾周脂肪外平面入路的平均手术时间(47±13)min,术中平均出血量(32±9)ml;经后腹腔肾周脂肪外途径平均手术时间(66±19)min,术中平均出血量(35±11)ml。3例中转开放,术中输血1例,术后高血压危象1例。经腹组在手术时间、出血量控制控制等方面优于后腹腔组。在较大直径的肾上腺肿瘤及肥胖患者人群中经腹组也具有优势。手术并发症及术后恢复方面两组间差异无统计学意义。结论经腹和经腹膜后的肾周脂肪外层面入路行腹腔镜肾上腺切除术均可达到安全、满意的疗效。

Objective To explore the surgical techniques and clinical efficacy of adrenalectomy through the extraperitoneal approach of perirenal fat.Methods Clinical data of 136 patients with adrenal tumors undergoing adrenalectomy in the Third Affiliated Hospital of Sun Yat-sen University and Southern University of Science&Technology School of Medicine from January 2018 to December 2018 were retrospectively analyzed.Among them,97 cases were treated via the extraperitoneal approach of perirenal fat and 39 patients via the retroperitoneal approach.The intraoperative and postoperative conditions of the patients were compared between two groups.Results All 136 patients successfully completed the surgery.In the extraperitoneal approach of perirenal fat group,the average operation time was(47±13)min and the average intraoperative blood loss was(32±9)ml,and(66±19)min and(35±11)ml in the other group.Three patients were switched to open surgery,1 case of intraoperative blood transfusion,and 1 case of postoperative hypertensive crisis.During adrenalectomy through the extraperitoneal approach of perirenal fat,the operation time and blood loss were better compared with those in the retroperitoneal group.The transabdominal technique was advantageous to the retroperitoneal approach for patients with large diameter of adrenal tumors and obesity.No statistical difference was observed in surgical complications and postoperative recovery between two groups.Conclusion Laparoscopic adrenalectomy through the trans-abdominal and retroperitoneal approach of perirenal fat can achieve safe and satisfactory clinical efficacy.