解剖程序化六步法后腹腔镜肾上腺切除术的临床应用

Clinical application research of anatomical and programmed retroperitoneoscopic adrenalectomy by six-step procedure

目的探讨解剖程序化六步法在后腹腔镜肾上腺切除术中的临床应用价值。方法选择2018年7月-2019年9月在该院治疗的50例肾上腺肿瘤患者作为研究对象,按照随机数字表法将患者分为A组(25例)和B组(25例),手术方式分别采用经腹腹腔镜肾上腺切除术和解剖程序化六步法后腹腔镜肾上腺切除术。比较两组患者手术时间、术中出血量、术后下床活动时间、术后肠道功能恢复时间、疼痛视觉模拟评分(VAS)、术后引流管拔除时间、术后住院时间、术中切除肾上腺时最高收缩压(SBP)和舒张压(DBP)、术中并发症(肠管损伤、胰腺损伤、高血压危象)和术后并发症(切口感染、肺部感染、肠梗阻、高血压危象、下肢深静脉血栓)发生率的差异。结果两组患者术中出血量、术后引流管拔除时间比较,差异均无统计学意义(P>0.05);B组患者手术时间、术后下床活动时间、术后肠道功能恢复时间、术后住院时间均短于A组(P<0.05),疼痛VAS评分低于A组(P<0.05),术中切除肾上腺时最高SBP和DBP波动的幅度均小于A组(P<0.05);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05);B组术中并发症发生率低于A组(P<0.05)。结论解剖程序化六步法后腹腔镜肾上腺切除术治疗直径<6.00 cm肾上腺肿瘤是安全有效的,术中利用解剖标志和无血管平面,依序手术操作,解剖结构清楚,先早期处理肾上腺中央静脉,后处理肾上腺,有利于保持术中血流动力学的稳定,降低后腹腔镜手术操作难度和围术期的手术风险,从而改善患者的临床疗效。

Objective To investigate the clinical application value of anatomical and programmed retroperitoneoscopic adrenalectomy by six-step procedure.Methods From July 2018 to September 2019,50 patients with adrenal tumors treated were selected as the study subjects.They were divided into group A(25 cases)and group B(25 cases)by the random number table method.The methods used in group A and group B were respectively for transabdominal laparoscopic adrenalectomy and anatomical and programmed retroperitoneoscopic adrenalectomy by six-step procedure.The operation time,intraoperative blood loss,postoperative get out bed activity,postoperative intestinal function recovery time,visual analogue scale(VAS)for pain,postoperative drainage tube removal time,post-hospitalization time,the highest systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the intraoperative removal of the adrenal gland,intraoperative complications(intestinal tube injury,pancreatic injury,hypertensive crisis,etc.)and the incidence of postoperative complications(incision infection,pulmonary infection,intestinal obstruction,hypertensive crisis,deep venous thrombosis of the lower extremities)for the two groups were compared.Results The intraoperative blood loss and postoperative drainage tube removal time between the two groups were no significant difference(P>0.05).The time of operation,postoperative get out bed activity,postoperative intestinal function recovery,postoperative hospital stay in group B were shorter than those in group A(P<0.05).The VAS pain score in group B was lower than those in group A(P<0.05).The range of volatility of the highest systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the intraoperative removal of the adrenal gland in group B were lesser than those in group A(P<0.05).The incidence of postoperative complications between the two groups were no significant difference(P>0.05).The incidence of intraoperative complications in group B were lower than those in group A(P<0.05).Conclusion The anatomical and programmed retroperitoneoscopic adrenalectomy by six-step procedure is safe and effective in the treatment of adrenal tumors<6.00 cm in diameter.Intraoperative use of anatomical landmarks and avascular plane,sequential surgical operation,clear anatomical structure,early treatment of the adrenal central vein,post-processing the adrenal gland,is conducive to maintaining the stability of intraoperative hemodynamics,reducing the difficulty of postoperative laparoscopic surgery and perioperative surgical risk,thereby improving the clinical efficacy of patients.