耻骨上辅助单孔腹腔镜手术与后腹腔镜手术治疗肾上腺囊肿的疗效分析

Suprapubic-assisted laparoendoscopic single-site surgery versus retroperitoneal laparoscopic surgery in adrenal cysts: a retrospective analysis

目的:比较耻骨上辅助单孔腹腔镜手术(SA-LESS)与后腹腔镜手术(RPLS)治疗肾上腺囊肿的疗效。方法:回顾性分析赣南医学院第一附属医院2014年1月-2019年8月收治的23例肾上腺囊肿患者的临床资料,其中男11例,女12例;年龄22~63岁,平均41岁;囊肿最大径3.10~11.10 cm,平均5.99 cm;左侧16例,右侧7例。除3例因腰腹部就诊外,均为体检发现。按手术方式分为SA-LESS组(15例)和RPLS组(8例)。比较两组患者基本信息、围手术期资料。结果:两组患者在性别比例、BMI、囊肿最大径、侧别等方面比较差异无统计学意义,SA-LESS组平均年龄(37.20±9.56)岁,显著低于RPLS组(48.13±13.32)岁(P<0.05)。23例手术均成功,无术中及术后严重并发症发生。两组手术时间、术中失血量、引流管拔除时间及术后住院时间比较差异无统计学意义。在SA-LESS组胃肠道功能恢复时间(18.40±4.79) h长于RPLS组(12.75±5.65) h,差异有统计学意义(P<0.05)。术后48 h视觉模拟疼痛评分(VAPS),SA-LESS组显著低于RPLS组[(1.60±0.63)分vs.(2.25±0.46)分,P<0.05]。术后3个月患者瘢痕评价调查问卷(PSAQ)评分,SA-LESS组显著低于RPLS组[(32.33±1.98)分vs.(39.88±2.85)分,P<0.05]。术后病理报告示:肾上腺内皮性囊肿12例,假性囊肿11例。术后随访24~84个月,平均46.3个月,囊肿均无复发。结论:SA-LESS与RPLS治疗肾上腺囊肿安全、有效,与RPLS比较,SA-LESS术后疼痛更轻,美容效果更佳。

Objective: To verify the feasibility and safety of suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS) versus retroperitoneal laparoscopic surgery(RPLS) in treatment of adrenal cysts. Methods: A total of 23 patients with adrenal cysts were treated by SA-LESS versus RPLS from January 2014 to August 2019, including 11 males and 12 females. The median age was 41(22-63) years. The adrenal cysts were located at the left side in 16 cases, right side in 7 cases. The maximum diameter of cysts ranged from 3.10 cm to 11.10 cm(average, 5.99 cm). Only 3 patients had back pain and abdominal pain. These patients underwent SA-LESS(15 cases) versus RPLS(8 cases), respectively. Clinical characteristics and preoperative data of patients were compared between two groups. Results: There was no obvious difference in gender, BMI, maximum diameter, location between two groups, the median age in SA-LESS was(37.20±9.56) years, which younger than RPLS groups(48.13±13.32) years, P<0.05. All 23 cases were successfully completed, without any intraoperative complications or conversion to open surgery. No difference between two groups with operative time, estimated blood loss, drainage tube removal time and postoperative hospitalization. Intestinal recovery time of SA-LESS group(18.40±4.79) h was longer than RPLS group(12.75±5.65) h, with a statistically significant difference(P<0.05). Visual analog pain scale score at 48 h postoperatively of SA-LESS group was significantly lower than RPLS group[(1.60±0.63) scores vs.(2.25±0.46) scores, P<0.05]. Patient scar assessment questionnaire score at 3 m after operation of SA-LESS group was significantly lower than RPLS group[(32.33±1.98) scores vs.(39.88±2.85) scores, P<0.05]. Postoperative pathological results showed 12 cases of epithelial cysts and 11 cases of pseudocysts. Follow-up period ranged from 24 to 84 months(average, 46.3 months). No sign of recurrence was found. Conclusion: SA-LESS and RPLS for adrenal cysts are safe and feasible. SA-LESS confers lower postoperative pain and better cosmetic result compared with RPLS.