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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 different characteristics of laparoscopic adrenal gland tumor surgery after peritoneal and retroperitoneal approaches and to explore the choice of laparoscopic adrenal gland tumor surgery. Methods: 13 cases of laparoscopic adrenalectomy performed from July 2012 to November 2014 were retrospectively analyzed. Among them, 7 cases were treated by peritoneal approach and 6 cases were treated by retroperitoneal approach. Tumor diameter, operation time, intraoperative blood loss, postoperative average time to bed, intestinal function recovery time and postoperative average length of stay, intraoperative and postoperative complications were compared. Results: There was no significant difference in mean diameter of tumor, mean operative time and mean intraoperative blood loss between the two groups (P> 0.05). The mean time to bed ambulation, the average recovery time of intestinal function and the mean postoperative hospital stay were statistically significant Significance (P <0.05). One case of intra-peritoneal route surgery underwent open-vessel surgery of inferior vena cava. All the 13 patients were followed up for 1 ~ 25 months with an average of 12.2 months. No postoperative complications occurred. Conclusions: Two kinds of laparoscopic adrenal gigantic tumor surgery are safe and feasible. The two surgical approaches have their own advantages and disadvantages. The retroperitoneal approach is better than the transabdominal approach in postoperative recovery.