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目的探讨经后腹腔镜肾上腺肿瘤切除术后原位复发患者,行经腹腹腔镜肾上腺肿瘤切除术的可行性和安全性。方法回顾性分析2013年1月至2015年6月本中心收治的肾上腺肿瘤原位复发患者23例的临床资料,23例中再次行开放手术14例,行腹腔镜手术9例。比较两种术式术中及围术期评价指标,包括手术时间、术中失血量、术中输血量、术后禁食时间、下床活动时间、术后住院时间等,以及术中和术后并发症的发生率,包括气胸、皮下气肿、血管损伤、脏器损伤、下肢深静脉血栓等。结果两种术式的手术时间、术中输血量和术后禁食时间比较,差异均无统计学意义(P均>0.05)。与开放手术相比,腹腔镜手术术中失血量少(P<0.05),术后下床活动时间早(P<0.05),术后住院时间短(P<0.05)。两组患者均未出现严重术中及术后并发症,随访13~37个月,无死亡病例。结论对于经后腹腔镜肾上腺肿瘤切除术后原位复发的患者,与开放手术相比,再次经腹腔腹腔镜肾上腺肿瘤切除术是一种安全可行的手术方式,有利于减少术中出血,加快患者术后康复。
Objective To investigate the feasibility and safety of laparoscopic adrenalectomy in patients with recurrent laparoscopic adenoidectomy after retroperitoneal laparoscopic adrenalectomy. Methods The clinical data of 23 patients with adrenal tumor recurred in our center from January 2013 to June 2015 were analyzed retrospectively. Of the 23 patients, 14 were underwent open surgery again and 9 underwent laparoscopic operation. Comparison of two kinds of intraoperative and perioperative evaluation indicators, including operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative fasting time, ambulation time, postoperative hospital stay, and intraoperative and postoperative The incidence of postoperative complications, including pneumothorax, subcutaneous emphysema, vascular injury, organ damage, lower extremity deep vein thrombosis. Results There were no significant differences in operation time, intraoperative blood transfusion and postoperative fasting time (P> 0.05). Compared with the open surgery, laparoscopic surgery less blood loss (P <0.05), ambulation after bedtime (P <0.05), shorter postoperative hospital stay (P <0.05). There was no serious intraoperative and postoperative complications in both groups. All cases were followed up for 13 to 37 months without any deaths. Conclusions Transabdominal laparoscopic adrenalectomy is a safe and feasible surgical modality for postoperative patients with retroperitoneal relapse after retroperitoneal laparoscopic adrenalectomy compared with open surgery, which helps to reduce intraoperative bleeding and speed up patients Postoperative recovery.