经腹膜后与经腹腔入路在腹腔镜下侧位肾上腺手术中的效果分析

Effect analysis of laparoscopic lateral adrenalectomy by retroperitoneal and transperitoneal approaches

目的分析并对比经腹膜后与经腹腔入路方式在腹腔镜下侧位肾上腺手术中的效果。方法46例行腹腔镜下侧位肾上腺手术患者,按照手术入路方法不同分为A组及B组,每组23例。A组采用经腹膜后入路方式开展手术,B组采用经腹腔入路方式实施手术。分析两组手术情况并比较两组手术用时、术中出血量、胃肠功能恢复时间、住院时间、手术操作舒适度评分、术后疼痛评分及并发症发生情况。结果经病理诊断,46例患者均为肾上腺腺瘤,对两组患者开展腹腔镜下侧位肾上腺手术,均获得成功,手术成功率均为100.00%,手术效果满意。两组术后无输血治疗情况,仅B组术中1例出现肾上腺中央静脉损伤,转为开放手术。两组患者手术用时、术中出血量比较,差异无统计学意义(P>0.05);A组患者胃肠功能恢复时间(2.35±0.56)d、住院时间(3.53±0.23)d短于B组的(4.63±0.89)、(6.75±0.52)d,差异具有统计学意义(P<0.05)。A组手术操作舒适度评分(5.32±0.56)分、术后疼痛评分(4.01±0.12)分均低于B组的(8.34±1.03)、(6.67±0.69)分,差异有统计学意义(P<0.05)。两组术后均获随访,无严重并发症,预后良好。结论在开展腹腔镜下侧位肾上腺手术时,经腹膜后与经腹腔两种入路方式,均可发挥显著效果,但是经腹膜后入路方式能够提高术中操作舒适度,降低术后疼痛感,同时胃肠道功能恢复时间更短,对保证手术操作安全具有重要保障。

Objective To analyze and compare the effect of laparoscopic lateral adrenalectomy by retroperitoneal and transperitoneal approaches.Methods A total of 46 patients who underwent laparoscopic lateral adrenalectomy were divided into group A and group B according to different surgical approaches,with 23 cases in each group.Group A was operated by retroperitoneal approach,and group B was operated by transperitoneal approach.The surgical conditions of the two groups were analyzed.Both groups were compared in terms of operation time,intraoperative blood loss,recovery time of gastrointestinal function,hospitalization time,operation comfort score,postoperative pain score and complications.Results After pathological diagnosis,46 patients were all adrenal adenomas.Laparoscopic lateral adrenalectomy was performed successfully in both groups,with a success rate of 100.00%,and the surgical results were satisfactory.There was no blood transfusion treatment in the two groups after surgery.Only 1 patient in group B had central adrenal vein injury during the surgery and was converted to open surgery.There was no statistically significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).The recovery time of gastrointestinal function(2.35±0.56)d and hospitalization time(3.53±0.23)d in group A were shorter than(4.63±0.89)and(6.75±0.52)d in group B,and the differences were statistically significant(P<0.05).The operation comfort score(5.32±0.56)points and postoperative pain score(4.01±0.12)points of group A were lower than(8.34±1.03)and(6.67±0.69)points of group B,and the difference was statistically significant(P<0.05).Both groups were followed up with no serious complications and had a good prognosis after surgery.Conclusion Both retroperitoneal and transperitoneal approaches can play a significant role in laparoscopic lateral adrenalectomy,but retroperitoneal approach can improve intraoperative comfort,reduce postoperative pain,and shorten the recovery time of gastrointestinal function,which has an important guarantee for the safety of surgery.