经腹腔与经腹膜后入路腹腔镜下肾上腺巨大肿瘤手术的疗效分析

Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy(adrena tumors>6cm)

目的:比较经腹腔与经腹膜后入路腹腔镜下肾上腺巨大肿瘤手术的不同特点,探讨腹腔镜下肾上腺巨大肿瘤手术的入路选择。方法:回顾分析2012年7月~2014月11月施行的13例腹腔镜肾上腺手术经验,其中经腹腔入路7例,经腹膜后入路6例。对肿瘤直径,手术时间,术中出血量,术后平均下床时间,肠道功能恢复时间及术后平均住院日,术中、术后并发症等指标进行比较。结果:肿瘤平均直径、平均手术时间、术中平均出血量两组差异无统计学意义(P】0.05),术后平均下床时间、肠功能平均恢复时间、术后平均住院时间差异有统计学意义(P【0.05)。术中经腹腔途径组1例发生损伤下腔静脉中转开放手术。13例患者均获随访,随访1~25个月,平均12.2个月,均未出现术后并发症。结论:两种不同的入路施行腹腔镜肾上腺巨大肿瘤手术都是安全可行的,两种手术入路各有优缺点,经腹膜后入路在术后恢复方面优于经腹腔入路。

Objective:To compare the characteristics of transperitoneal versus retroperitoneal laparoscopic adrenalectomy and investigate the approach of laparoscopic adrenalectomy(adrena tumors>6cm).Methods:Retrospective analysis of 13 cases who underwent laparoscopic adrenalectomy from July 2012 to November 2014 was conducted.Of these cases,7underwent transperitoneal laparoscopic adrenalectomy and 6retroperitoneal 1aparoscopic adrenalectomy.The mean data of tumor size,operative time,blood loss,time to ambulation,time to postoperative intake,and complications of the modalities were compared.Results:No significant differences(all P>0.05)were found in the mean data of tumor size,operative time,blood loss,complications.The indwelling time of drainage tume was shorter,the eating time was earlier,and hospital stay was shorter in retroperitoneal laparoscopic group than in transabdominal group.No recurrence was detected biochemically during a mean follow up of 12.2months(range 1-25months).In transperitoneal access patients,1case was transferred to open surgery for injury of inferior vena cava.In retroperitoneal access patients,all cases operated successfully.Conclusions:Both the transperitoneal and retropefitoneal laparoscopic approaches are feasible and safe for adrenalectomy,and two approaches have advantages and disadvantages of each.The retroperitoneal laparoscopic group had shorter recovery time than transabdominal group.