两种腔镜入路治疗较大体积肾上腺肿瘤的疗效分析

Efficacy analysis of two different laparoscopic approaches in the treatment of large adrenal tumors

目的:探讨腹腔镜下采用两种入路治疗直径≥5 cm肾上腺肿瘤的临床疗效及安全性。方法:选取2017年1月至2021年8月手术治疗的48例直径>5 cm的肾上腺肿瘤患者,根据入路方式分为腹膜后组(n=24)与经腹腔组(n=24)。对比分析两组围手术期指标、手术效果。结果:两组术中出血量、术后拔除引流管时间、术后住院时间差异无统计学意义(P>0.05),腹膜后组术中皮下气肿、肿瘤破裂例数多于经腹腔组(P<0.05),手术时间长于经腹腔组(P<0.05),术后首次排气时间短于经腹腔组(P<0.05)。结论:腹腔镜经后腹腔与经腹腔入路切除较大肾上腺肿瘤均是可选择的入路方式,临床应结合肿瘤大小、位置、性质、瘤体与邻近脏器的关系、术者操作习惯及患者基本情况选择合理的手术入路。

Objective:To investigate the clinical efficacy and safety of two different methods of laparoscopy for the treatment of adrenal tumors≥5 cm.Methods:According to different endoscopic surgical approaches,48 cases of adrenal tumors with tumor diameter greater than 5 cm from Jan.2017 to Aug.2021 were divided into 2 groups(24 cases in retroperitoneal group and 24 cases in transabdominal group).Perioperative indexes and surgical effects were compared between the two groups.Results:There were no significant differences in intraoperative blood loss,postoperative drainage tube removal time and postoperative hospital stay between the two groups(P>0.05).The number of intraoperative subcutaneous emphysema and tumor rupture in the retroperitoneal group was more than that in the transabdominal group(P<0.05),and the operation time was longer than that in the transabdominal group,the difference was statistically significant(P<0.05).The first postoperative exhaust time in the retroperitoneal group was earlier than that in the transabdominal group,and the difference was statistically significant(P<0.05).Conclusions:Both retroperitoneal and transperitoneal resection of large adrenal tumor are optional surgical methods.However,in clinical practice,a reasonable surgical approach should be selected based on the size,location,nature of the tumor,the relationship between the tumor and adjacent organs,the operation habits of the surgeon and the basic situation of the patient.