后腹腔镜下精准解剖性左侧肾上腺切除术

Retroperitoneoscopic accurate anatomical left adrenalectomy

摘要:

目的 探讨后腹腔镜下精准解剖性左侧肾上腺切除术的可行性和安全性。方法 回顾性分析2018年1月－2019年3月该院实施后腹腔镜下精准解剖性左侧肾上腺切除术的107例住院患者的临床资料（试验组），并与2016年1月－2018年12月实施后腹腔镜下解剖性左侧肾上腺切除术的95例住院患者的临床资料进行对比（对照组）。统计分析两组患者手术时间、术中出血量、术后引流量、术后住院时间、术后胃肠功能恢复时间、术后止痛剂用量和术中术后并发症发生率。结果 两组患者均顺利完成手术，无中转开放及输血病例。试验组手术时间较对照组短［（43.6±10.5）和（67.8±15.1）min］，术中出血量较对照组少［（29.3±12.5）和（69.4±25.5）mL］，腹膜损伤率较对照组低（4.7%和14.7%），差异均有统计学意义（P < 0.05）；试验组和对照组术后引流量［（79.4±22.3）和（81.9±26.9）mL］、术后住院时间［（5.9±0.7）和（5.8±0.7）d］、术后胃肠功能恢复时间［（17.7±4.4）和（16.7±3.6）d］和术后止痛剂用量［（167.3±79.8）和（174.7±77.1）mg］比较，差异均无统计学意义（P > 0.05）。结论 后腹腔镜下精准解剖性左侧肾上腺切除术安全、可行。与经典三层面法比较，其手术时间明显缩短，术中出血量明显减少，术中腹膜损伤发生率明显降低，值得临床推广应用。

Abstract:

Objective To investigate the feasibility and safety of retroperitoneoscopic accurate anatomical left adrenalectomy.Methods The consecutive clinical data and surgical video (trial group) of 107 cases of accurat anatomical left adrenalectomy from January 2018 to March 2019 were retrospectively analyzed, 95 cases of retroperitoneoscopy traditional left adrenalectomy (control group) from January 2016 to December 2018 were contrastively analyzed. The difference between the operative time, intraoperative blood loss, postoperative drainage volume, postoperative hospitalization, postoperative recovery time of gastrointestinal function, postoperative analgesic requirements and the incidence of intraoperative and postoperative complications were statistically analyzed.Results The two groups of patients have completed the operation with no conversion to open and blood transfusion. The trial group was compared to the control group, the mean operative time was shorter [(43.6 ± 10.5) min and (67.8 ± 15.1) min], the mean intraoperative blood loss was less [(29.3 ± 12.5) mL and (69.4 ± 25.5) mL], peritoneum damage rate was lower (4.7% and 14.7%), the differences were all statistically significant (P < 0.05); The two group of the mean postoperative drainage volume was [(79.4 ± 22.3) mL and (81.9 ± 26.9) mL], the mean postoperative hospitalization was [(5.9 ± 0.7) d and (5.8 ± 0.7) d], the mean postoperative recovery time of gastrointestinal function was [(17.7 ± 4.4) d and (16.7 ± 3.6) d], postoperative analgesic requirements was [(167.3 ± 79.8) mg and (174.7 ± 77.1) mg], the differences were not statistically significant (P > 0.05).Conclusion The retroperitoneoscopic accurate anatomical left adrenalectomy is safe and feasible. Compared with the classical three-level method, the operative time is significantly shortened, the mean intraoperative estimated blood loss is reduced, and the incidence of intraoperative peritoneal injury is significantly reduced, which is worthy of clinical application.