腹腔镜和后腹腔镜手术治疗肾上腺肿瘤的效果及对应激反应的影响

Clinical efficacy and stress response of laparoscopic and retroperitoneoscopic surgery for adrenal tumor

目的对比分析腹腔镜和后腹腔镜手术治疗肾上腺肿瘤(AT)的效果及对应激反应的影响。方法抽取2018年1月至2020年12月商丘市第一人民医院收治的AT患者64例,按随机数字表法分为后腹腔镜组与腹腔镜组,每组32例。腹腔镜组行腹腔镜手术,后腹腔镜组行后腹腔镜手术。对比两组围术期情况、术后恢复情况、应激反应(皮质醇、白细胞计数)及血流动力学(平均动脉压、心率)。结果后腹腔镜组手术时间短于腹腔镜组,术中出血量、术后引流量少于腹腔镜组(P<0.05);后腹腔镜组排气时间、肠道功能恢复时间、术后下床活动时间、住院时间均少于腹腔镜组(P均<0.05)。术后1 d,两组皮质醇、白细胞计数水平均高于术前,但后腹腔镜组升高幅度低于腹腔镜组(P<0.05)。气腹后30 min,两组平均动脉压、心率均高于气腹前(P<0.05),但组间比较差异未见统计学意义(P>0.05)。结论与腹腔镜手术相比,后腹腔镜手术治疗AT患者,可缩短手术时间,减少术中出血量和术后引流量,并可减轻应激反应,维持血流动力学稳定,加快患者术后恢复进程。

Objective To analyze the clinical effect of laparoscopic and retroperitoneoscopic surgery in the treatment of adrenal tumor(AT)and its effect on stress response.Methods Sixty-four AT patients treated in Shangqiu First People’s Hospital from January 2018 to December 2020 were selected and divided into retroperitoneoscopic group and laparoscopic group according to random number table method,with 32 cases in each group.Laparoscopic surgery was performed in the laparoscopic group,and retroperitoneoscopic surgery was performed in the retroperitoneoscopic group.The perioperative period condition,postoperative recovery,stress response(cortisol,white blood cell count)and hemodynamics(mean arterial pressure,heart rate)were compared between the two groups.Results The length of operation of the retroperitoneoscopic group was shorter than that of the laparoscopic group,and the intraoperative blood loss and postoperative drainage volume were less than those of the laparoscopic group(P<0.05).The evacuation time,recovery time of intestinal function,time of getting out of bed after operation,and hospital stay in the retroperitoneoscopic group were shorter than those in the laparoscopic group(all P<0.05).One day after operation,the level of cortisol and white blood cell count of the two groups were higher than those before the operation,but the increase in the retroperitoneoscopic group was lower than that in the laparoscopic group(P<0.05).Thirty minutes after pneumoperitoneum,the level of mean arterial pressure and heart rate of the two groups were higher than those before pneumoperitoneum(P<0.05),but there was no significant difference in these indexes between the groups(P>0.05).Conclusions Compared with laparoscopic surgery,retroperitoneoscopic surgery for AT patients can shorten the operation time,reduce intraoperative blood loss and postoperative drainage,reduce stress response,maintain hemodynamic stability,and speed up the postoperative recovery process of patients.