左右侧腹膜后腹腔镜肾上腺切除手术结果比较

Comparison of surgical outcomes between left and right retroperitoneal laparoscopic adrenalectomy

目的对比分析左侧和右侧腹膜后腹腔镜肾上腺切除术(retroperitoneal laparoscopic adrenalectomy,RLA)的手术结果差异。方法回顾性分析2018年1月至2021年12月首都医科大学附属北京安贞医院泌尿外科收治的RLA患者临床资料,包括年龄、性别、体质量指数(body mass index,BMI)、合并症(高血压、冠心病、糖尿病和呼吸系统疾病)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、既往腹部手术史、手术时间、术中出血量、瘤体大小、瘤体侧(左/右)、术后病理类型、围手术期并发症、术后住院时间等资料。对比分析左侧和右侧RLA在手术时间、术中出血量、围手术期并发症和术后住院时间的差异情况。结果本研究共纳入269例RLA患者,其中左侧150例、右侧119例。两组患者在年龄、性别、瘤体大小、BMI、ASA分级、既往腹部手术史、手术方式、病理类型、合并症方面差异没有统计学意义。左侧RLA和右侧RLA在中位手术时间分别为105.0 min(85.0 min,140.0 min)和115.0 min(95.0 min,145.0 min)(P=0.24),左侧的中位术中出血量为20 mL(10 mL,30 mL),右侧的中位术中出血量为20 mL(10 mL,30 mL)(P=0.72),左侧和右侧平均术后住院时间分别为(6.4±1.8)d和(6.7±1.5)d(P=0.16),差异均没有统计学意义。在围手术期并发症方面:左侧RLA Clavien-Dindo分级Ⅱ级以上并发症发生率为6.0%,右侧RLA发生率为16.0%,差异具有统计学意义(P=0.01)。结论左侧RLA和右侧相比,在术中出血量、手术时间、术后住院时间方面差异没有统计学意义。右侧RLA围手术期Clavien-Dindo分级Ⅱ级以上并发症发生率明显高于左侧,但Ⅲ级以上并发症发生率两者没有差异。

Objective The purpose of this study was to determine whether surgical outcomes are different for the left-versus right-sided retroperitoneal laparoscopic adrenalectomy(RLA).Methods A retrospective data gathering from 269 patients who underwent RLA from Jan.2018 to Dec.2021 was conducted.Demographic and hospital admission data were collected including age,sex,body mass index(BMI),comorbidities(hypertension,coronary heart disease,diabetes and respiratory diseases),American Society of Anesthesiologists(ASA)score,history of abdominal surgery,operative time,estimated blood loss(EBL),tumor size,laterality,postoperative pathology,perioperative complications and postoperative length of stay from these patients with complete medical records.The surgical outcomes including operative time,EBL,postoperative length of stay and complications were analyzed and compared between left-and right-sided group.Results Of the adrenalectomies performed,150 were on the left and 119 on the right.No significant difference was found between the two groups in terms of age,sex,BMI,comorbidities,ASA score,tumor size,resection procedure and pathology type of the lesions.The median operative time of the left and right-sided RLA was 105.0 min(85.0 min,140.0 min)and 115.0 min(95.0 min,145.0 min)(P=0.24),respectively.The median EBL on both the left and right side was 20 mL(10 mL,30 mL)(P=0.72).The mean postoperative length of stay between the left and right were(6.4±1.8)days and(6.7±1.5)days(P=0.16),respectively.There was no statistically significant difference in the above variables between left and right-sided RLA.The perioperative complication rate(Clavien-Dindo grade≥2)on the left and right side was 6.0%and 16.0%,respectively,which is statistically significant(P=0.01).However,there was no difference in Clavien-Dindo grade≥3 complications between left-and right-sided groups(P=0.85).Conclusions No significant difference was found between the left and right laparoscopic adrenalectomy in terms of operative time,EBL,postoperative length of stay and occurrence of serious intraoperative complications.The incidence of perioperative complications above gradeⅡbased on Clavien-Dindo classification on the right side was significantly higher than that on the left side,but there was no difference above gradeⅢ.