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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 215 -220. doi: 10.3877/cma.j.issn.1674-3253.2021.03.008

临床研究

术前CT辅助规划经腹和腹膜后腹腔镜肾上腺切除术的比较:附509例报告
李星豪1, 柳政1, 吴杰英1, 李腾成1, 李茂胤1, 方友强1,()   
  1. 1. 510630 广州,中山大学附属第三医院泌尿外科
  • 收稿日期:2020-11-05 出版日期:2021-06-01
  • 通信作者: 方友强
  • 基金资助:
    广州市科技计划项目(201704020052)

Comparison of transperitoneal and retroperitoneal laparoscopic adrenalectomy under preoperative CT-assisted program: report of 509 cases

Xinghao Li1, Zheng Liu1, Jieying Wu1, Tengcheng Li1, Maoyin Li1, Youqiang Fang1,()   

  1. 1. Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2020-11-05 Published:2021-06-01
  • Corresponding author: Youqiang Fang
引用本文:

李星豪, 柳政, 吴杰英, 李腾成, 李茂胤, 方友强. 术前CT辅助规划经腹和腹膜后腹腔镜肾上腺切除术的比较:附509例报告[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(03): 215-220.

Xinghao Li, Zheng Liu, Jieying Wu, Tengcheng Li, Maoyin Li, Youqiang Fang. Comparison of transperitoneal and retroperitoneal laparoscopic adrenalectomy under preoperative CT-assisted program: report of 509 cases[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 215-220.

目的

比较术前CT辅助规划下经腹途径腹腔镜肾上腺切除术(TLA)与经腹膜后途经腹腔镜肾上腺切除术(RLA)两种术式的临床效果。

方法

回顾性分析我院自2009年1月至2019年4月行腹腔镜肾上腺切除术的患者共509例。其中采用TLA入路246例,RLA入路263例,所有患者术前均行CT检查,比较两组的围手术期指标;并通过倾向性评分匹配(PSM)将两组平衡为207对,比较两种术式的疗效与并发症。

结果

509例手术均取得成功,PSM后,两组在性别、年龄、体质量指数(BMI)、肿瘤部位、肿瘤直径、ASA分级差异无统计学意义。两组患者在术中出血量、术后引流量、中转开放率、并发症发生率、术后进食天数等方面差异无统计学意义;在手术时间[(125±51)min vs(139±57)min,P=0.012]、手术前后血红蛋白(Hb)差值[(10.35±9.60)g/L vs(14.60±10.16) g/L,P<0.01]、术后住院天数[5(4)d vs 7(3)d,P<0.01]方面TLA组要优于RLA组。

结论

TLA与RLA入路均可达到安全、满意的疗效。术前CT辅助规划下的TLA由于能够提供肾上腺中央静脉解剖的准确识别,在手术时间及出血量等方面更具优势,对于有经验的手术医师我们更推荐采用TLA入路完成手术。

Objective

To compare the clinical effects of transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA) under preoperative CT-assisted programming.

Methods

The data of 509 patients underwent laparoscopic adrenalectomy in our hospital from January 2009 to April 2019 were retrospectively analyzed. Among them, 246 cases were treated with TLA approach and 263 cases with RLA approach. All patients received perioperative CT examination, and the perioperative indicators of the two groups were compared.The balance of the two groups was 207 pairs by propensity score matching (PSM), and the efficacy and complications of the two surgical methods were compared.

Results

All the 509 patients were successfully operated. After PSM, there were no statistically significant differences in gender, age, body mass index (BMI), tumor site, tumor diameter or ASA classification between the two groups. There were no statistically significant differences between the two groups in terms of intraoperative blood loss, postoperative drainage volume, transfer rate, incidence of complications, postoperative feeding days. The TLA group was superior to the RLA group in operation time [(125±51) min vs (139±57) min, P=0.012], hemoglobin (Hb) difference [(10.35±9.60) g/Lvs (14.60±10.16) g/L, P<0.01], postoperative hospital stay [5(4) d vs 7(3) d, P<0.01].

Conclusions

Both TLA and RLA approach can achieve safe and satisfactory curative effect. TLA under preoperative CT-assisted planning is more advantageous in terms of operation time and blood loss due to its ability to provide accurate identification of adrenal vein anatomy. Therefore, TLA approach is more recommended for experienced surgeons to complete the operation.

图2 腹腔镜下经腹途径右侧肾上腺皮质腺瘤切除术
表1 两组肾上腺肿瘤患者倾向性得分匹配后术前临床资料的比较
表2 两组肾上腺肿瘤患者倾向性得分匹配后术中及术后基本情况的比较
表3 两组肾上腺肿瘤患者倾向性得分匹配后并发症的比较[例(%)]
表4 两组肾上腺肿瘤患者倾向性得分匹配后术后病理结果(例)
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