论文部分内容阅读
目的总结腹腔镜手术与开放手术在肾上腺疾病外科治疗中的临床经验。方法回顾性分析486例肾上腺疾病患者的临床资料,其中478例行手术治疗,包括开放手术组318例和腹腔镜手术组160例。比较两组手术时间、术中出血量、术后肠功能恢复时间、术后疼痛、术后住院天数及手术并发症等方面的差异。结果开放手术组手术全部成功;腹腔镜手术组154例成功,6例中转开放后成功切除肿瘤。腹腔镜手术组切除肿瘤直径>6 cm 者9例,恶性肿瘤3例,随访3～20个月无复发或转移。两组平均手术时间分别为(112±16)min、(69±10)min,术中平均出血量分别为(286±23)ml、(56±10)ml,术后平均肠功能恢复时间分别为(66±7)h、(24±7)h,术后平均镇痛次数分别为(1.9±0.4)次、(0.5±0.1)次,平均住院天数分别为(10.3±1.1)d、(7.2±0.7)d,并发症发生率分别为40.3%、7.5%,差异有统计学意义(P=0.023,0.007,0.039,0.003,0.029,0.001)。结论腹腔镜肾上腺切除术在手术时间、术中出血量、术后肠功能恢复时间、术后痛疼、住院天数以及并发症发生率等方面均优于传统的开放手术,已成为大部分良性肾上腺疾病治疗的金标准,但在大体积和恶性肿瘤的治疗中仍存在一些限制,正确地选择手术适应证和完善的围手术处理至关重要。
Objective To summarize the clinical experience of laparoscopic surgery and open surgery in the surgical treatment of adrenal diseases. Methods The clinical data of 486 patients with adrenal diseases were retrospectively analyzed. Among them, 478 patients underwent surgical treatment, including 318 cases of open surgery group and 160 cases of laparoscopic surgery group. The differences of operative time, intraoperative blood loss, postoperative intestinal function recovery time, postoperative pain, postoperative hospital days and surgical complications were compared. Results All the operations were successful in the open surgery group; 154 cases were successful in the laparoscopic surgery group and 6 cases were successful in the resection of the tumor after the transfer was completed. In laparoscopic surgery group, there were 9 cases with tumors> 6 cm in diameter and 3 cases with malignant tumors. No recurrence or metastasis was observed during 3 to 20 months of follow-up. The mean operative time was (112 ± 16) min and (69 ± 10) min respectively in the two groups. The mean intraoperative blood loss were (286 ± 23) ml and (56 ± 10) ml, respectively. The mean number of postoperative analgesia were (66 ± 7) h and (24 ± 7) h, respectively, and the average number of postoperative analgesia was (1.9 ± 0.4) and (0.5 ± 0.1) 7.2 ± 0.7) d. The complication rates were 40.3% and 7.5%, respectively. The difference was statistically significant (P = 0.023,0.007,0.039,0.003,0.029,0.001). Conclusions Laparoscopic adrenalectomy is superior to traditional open surgery in terms of operation time, intraoperative blood loss, postoperative intestinal function recovery time, postoperative pain, hospitalization days and the incidence of complications, has become the majority of benign adrenal The gold standard for disease treatment, however, there are some limitations in the management of large volumes and malignancies, and the proper selection of surgical indications and well-established perioperative management are crucial.