免气腹单孔后腹腔镜肾上腺肿瘤切除术初步探讨

doi:10.3877/cma.j.issn.1674-3253.2024.01.005

目的

总结分析免气腹单孔后腹腔镜肾上腺肿瘤切除术的方法和围手术期资料，探讨免气腹单孔后腹腔镜肾上腺肿瘤切除术的安全性和可行性。

方法

回顾性收集2020年10月至2022年3月中山大学肿瘤防治中心由同一术者完成的65例单孔后腹腔镜肾上腺肿瘤切除术患者的临床资料，其中免气腹单孔腹腔镜23例，有气腹单孔腹腔镜42例。

结果

65例单孔腹腔镜手术均成功完成，无中转开放或者改多孔操作。免气腹单孔腹腔镜组和有气腹单孔腹腔镜组在手术时间、术中出血量、术后住院时间、术后止痛药物使用时间、引流管留置时间差异均无统计学意义（P>0.05）；免气腹组住院平均费用低于气腹组[（32 072±2 667 vs 34 972±2 783）元，P<0.001]。

结论

免气腹单孔后腹腔镜肾上腺肿瘤切除术安全可行，能避免气腹并发症，减少患者住院费用，是一种微创，美容和经济的术式。

关键词: 免气腹, 单孔，腹腔镜, 肾上腺肿瘤

Objective

To explore the safety and feasibility of single-port gasless retroperitoneal laparoscopic adrenalectomy (SGRLA) for adrenal tumors.

Methods

The clinical data of 65 patients undergoing single-port posterior laparoscopic adrenal tumor resection by the same operator from October 2020 to March 2022 in Sun Yet-Sen University Cancer Center were retrospectively collected and analyzed, including 23 cases of SGRLA and 42 cases of conventional single-port laparoscopy.

Results

All the surgical procedures were successfully completed without intermediate opening or conversion to multi-port operation. Baseline characteristcs were balanced between the two groups. There were no significant difference between the SGRLA group and the conventional single-port laparoscopy group in terms of operative time, intraoperative bleeding, postoperative hospital stay, postoperative pain medication duration, and drainage tube retention time (P>0.05); the mean cost of hospitalization was lower in the SGRLA than in the traditional group [(32 072 ±2 667) vs (34 972 ± 2 783 yuan), P<0.001].

Conclusion

Single-port gasless retroperitoneal laparoscopic adrenalectomy is safe and feasible, which can avoid the complications of pneumoperitoneum, reduce hospitalization costs of patients, and is a minimally invasive cosmetic and economic procedure.

Key words: Gasless, Single-port, laparoscopy, Adrenal tumor

图1 免气腹单孔后腹腔镜肾上腺肿瘤切除术注：a1为手术器械和耗材，a2为第11和12肋间切口，a3为置入4-0切口保护套，b1为清除腹膜外脂肪，b2为打开肾周筋膜，b3为腹膜牵开器维持腹膜后空间，c1为显露腹膜平面，c2为显露肾上极平面，c3为显露肾膈肌平面，d1为显露下腔静脉，d2为切除部分粘连腹膜，d3为显露肾上腺中央静脉，e1为结扎肾上腺中央静脉，e2为术后切口，e3为术后病理大体标本

表1 两组单孔后腹腔镜肾上腺肿瘤切除术患者资料对比

组别	例数	年龄[岁，(±s)]	性别(例)		BMI[(kg/m²，(±s)]	肿瘤位置(例)		肿瘤最大径[cm，(±s)]	手术时间[min，(±s)]	术中出血量[ml，M(Q)]	术后住院时间[d，(±s)]
组别	例数	年龄[岁，(±s)]	男	女	BMI[(kg/m²，(±s)]	左	右	肿瘤最大径[cm，(±s)]	手术时间[min，(±s)]	术中出血量[ml，M(Q)]	术后住院时间[d，(±s)]
有气腹组	42	50±14	13	29	23±4	24	18	2.4±0.9	66±22	10(10，20)	2.7±0.7
免气腹组	23	48±14	10	13	23±3	14	9	2.8±1.0	67±19	10(10，30)	2.9±0.8
P值		0.611	0.313		0.994	0.771		0.090	0.949	0.454	0.426
组别	病理类型(例)				输血(例)	中转开放(例)	术后止痛药物使用时间[d，(±s)]	引流管留置时间[d，(±s)]	保留部分肾上腺(例)		住院费用[元，(±s)]
组别	无功能皮质腺瘤	嗜铬细胞瘤	转移瘤	其他	输血(例)	中转开放(例)	术后止痛药物使用时间[d，(±s)]	引流管留置时间[d，(±s)]	是	否	住院费用[元，(±s)]
有气腹组	26	6	6	4	0	0	1.8±0.6	2.3±0.9	30	12	34 972±2 783
免气腹组	12	5	3	3	0	0	2.1±0.7	2.4±0.6	13	10	32 072± 2 667
P值	0.822				-	-	0.090	0.691	0.225		<0.001

表1 两组单孔后腹腔镜肾上腺肿瘤切除术患者资料对比

组别	例数	年龄[岁，(±s)]	性别(例)		BMI[(kg/m²，(±s)]	肿瘤位置(例)		肿瘤最大径[cm，(±s)]	手术时间[min，(±s)]	术中出血量[ml，M(Q)]	术后住院时间[d，(±s)]
组别	例数	年龄[岁，(±s)]	男	女	BMI[(kg/m²，(±s)]	左	右	肿瘤最大径[cm，(±s)]	手术时间[min，(±s)]	术中出血量[ml，M(Q)]	术后住院时间[d，(±s)]
有气腹组	42	50±14	13	29	23±4	24	18	2.4±0.9	66±22	10(10，20)	2.7±0.7
免气腹组	23	48±14	10	13	23±3	14	9	2.8±1.0	67±19	10(10，30)	2.9±0.8
P值		0.611	0.313		0.994	0.771		0.090	0.949	0.454	0.426
组别	病理类型(例)				输血(例)	中转开放(例)	术后止痛药物使用时间[d，(±s)]	引流管留置时间[d，(±s)]	保留部分肾上腺(例)		住院费用[元，(±s)]
组别	无功能皮质腺瘤	嗜铬细胞瘤	转移瘤	其他	输血(例)	中转开放(例)	术后止痛药物使用时间[d，(±s)]	引流管留置时间[d，(±s)]	是	否	住院费用[元，(±s)]
有气腹组	26	6	6	4	0	0	1.8±0.6	2.3±0.9	30	12	34 972±2 783
免气腹组	12	5	3	3	0	0	2.1±0.7	2.4±0.6	13	10	32 072± 2 667
P值	0.822				-	-	0.090	0.691	0.225		<0.001

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Preliminary experience of single-port gasless retroperitoneal laparoscopic adrenalectomy

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Preliminary experience of single-port gasless retroperitoneal laparoscopic adrenalectomy