腹腔镜肾上腺切除术三种入路途径的临床比较

Clinical comparison of three different routes to laparoscopic adrenalectomy

目的 比较腹腔镜肾上腺切除术三种手术入路途径的临床效果 ,探讨适宜的手术入路途径。 方法 86例接受腹腔镜肾上腺切除术。采用三种不同的手术入路途径 (经腹腔前入路即TAA ,腹膜后侧入路即RLA ,腹膜后腰入路即RPA)。 结果 通过RPA及RLA途径完成手术 ,时间短于TAA(P <0 0 1)。在RLA和RPA中输血量少于TAA。在TAA ,住院时间明显长于在RPA和RLA。在并发症发生率和中转开放手术率方面 ,TAA明显高于RPA和RLA。在RPA和RLA ,中转开放手术经常是由于胸膜撕裂 ,特别在右侧 ;而在TAA经常是由于内脏损伤。 结论 后腹膜入路更加适于腹腔镜肾上腺切除术。

Ojective To research the appropriate routes the clinical results of the three different procedures for the laparoscopic adrenalectomy routes were compared. Methods Eighty six patients underwent laparoscopic adrenalectomy through three different routes-transperitoneal anterior (TAA), retroperitoneal lateral flank(RLA) and retroperitoneal posterior lumbar approaches(RPA). Results The time for performing operation through RPA and RLA was shorter than that through TAA(P<0 01) Blood transfusion during operation through RLA and RPA was less than that through TAA. The hospitalized days of patients operated on through TAA were significantly longer than those through RPA and RLA. The conversion rate was higher in TAA than that in RPA and RLA. The conversions were often resulted from pleura tears in RPA and RLA, especially on right side and from internal visceral injury in TAA. Conclusions The retroperitoneal approach has many advantages over the TAA. The retroperitoneal approach seems to be preferable for the laparoscopic adenalectomy.