改良解剖性三层面法后腹腔镜技术在肾上腺占位性病变中的应用体会

Application of modified anatomical three-dimensional laparoscopic technique in adrenal space-occupying lesions

目的探讨改良解剖性三层面法后腹腔镜技术在肾上腺占位性病变治疗中的优势及临床应用价值。方法回顾性分析安徽医科大学第一附属医院2018年4月至2019年3月收治并行后腹腔镜肾上腺肿瘤切除术的52例患者的临床资料,其中20例采用传统解剖性三层面分离法治疗设为对照组,32例采用改良解剖性三层面法治疗设为观察组,记录并比较两组患者的手术时间、术中出血量、术后引流管留置时间、术后并发症、住院时间及随访情况等指标。结果52例患者均成功实施后腹腔镜手术,无中转开放手术,术中无明显并发症发生,术后无感染、发热、肠梗阻及肾功能不全等并发症;观察组的手术时间和术中出血量低于对照组,差异有统计学意义(P<0.001);两组患者的引流管留置时间、术后肠功能恢复时间、术后住院时间比较,差异无统计学意义(P>0.05)。结论与传统的三层面法后腹腔镜肾上腺肿物切除术相比,改良后的术式安全可行,并可获得更加宽阔的操作空间和肾周视野,值得推广。

Objective To investigate the advantages and clinical application value of laparoscopic technique in the treatment of adrenal space-occupying lesions after improved anatomical three-layer method.Methods A retrospective analysis of the clinical data of 52 patients with laparoscopic adrenalectomy after the anatomical three-level resection was performed in the high-tech Institute of the first affiliated hospital of Anhui medical university from April 2018 to March 2019.Among them,20 cases used the traditional anatomical three-layer separation method as the control group,and 32 cases used the modified anatomical three-layer separation method as the observation group.The operation time,intraoperative blood loss,postoperative drainage tube indwelling time,postoperative complications,hospital stay and follow-up were recored and compared.Results All 52 patients were successfully treated with surgery.There was no open surgery,no complications during operation,no postoperative infection,fever,intestinal obstruction and renal insufficiency in all the patients.The operative time and intraoperative blood loss in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.001).There was no significant difference in drainage tube indwelling time,postoperative intestinal function recovery time and postoperative hospital stay between the two groups(P>0.05).Conclusions Compared with the traditional three-layer retroperitoneal laparoscopic adrenalectomy,the improved procedure is safe and feasible,and can obtain a wider operating space and perirenal vision.It has obvious technical advantages and is worthy of promotion.