经肾周脂肪囊内入路后腹腔镜肾上腺手术初步探讨

目的探讨经肾周脂肪囊内入路后腹腔镜肾上腺手术的安全性和可行性。 方法2015年1月1日至2018年12月30日，临沂市人民医院共收治252例肾上腺肿瘤患者。其中行经腹腔入路腹腔镜肾上腺手术115例(经腹腔组)，行经肾周脂肪囊内入路后腹腔镜肾上腺手术137例(经脂肪囊内组)。经肾周脂肪囊内入路后腹腔镜肾上腺手术方法：手术常规建立腹膜后空间，打开肾筋膜后直接经肾脏中上极与肾周脂肪囊之间的无血管层面分离、解剖肾上腺，行肾上腺全切术或部分切除术。分析、比较两组患者的手术时间、术中出血量、术后住院时间等临床资料。 结果经腹腔入路腹腔镜肾上腺手术115例及经肾周脂肪囊内入路后腹腔镜肾上腺手术137例均顺利完成，无一例中转开放手术。经腹腔入路腹腔镜肾上腺手术平均手术时间(52.7±19.7)min，平均术中出血量(33.1±23.2)ml，平均术后住院时间(3.5±0.9)d。经肾周脂肪囊内入路后腹腔镜肾上腺手术平均手术时间(54.4±22.7)min，平均术中出血量(31.8±21.4)ml，平均术后住院时间(2.8±0.4)d。两组比较，手术时间、术中出血量无统计学差异，经肾周脂肪囊内入路后腹腔镜肾上腺手术组术后住院时间缩短，差异有统计学意义。 结论经肾周脂肪囊内入路后腹腔镜肾上腺手术解剖肾上腺操作简便，患者术后康复较快，是安全可行的手术方式。

The experience of retroperitoneal laparoscopic adrenal surgery via intra-adipose capsule approach

ObjectiveTo investigate the safety and feasibility of retroperitoneal laparoscopic adrenal surgery via intra-adipose capsule approach. MethodsFrom Jan. 1st, 2015 to Dec. 30th, 2018, a total of 252 patients with adrenal tumors were admitted and treated with adrenal surgery. Among them, 115 patients underwent transperitoneal laparoscopic adrenal surgery, while 137 patients underwent retroperitoneal laparoscopic adrenal surgery through intra-adipose capsule approach. The method of retroperitoneal laparoscopic adrenal surgery through intra-adipose capsule approach was as followed: after the retroperitoneal working space was established routinely and Gerota fascia was dissected, adrenal glands were sought directly at the non-vascular layer between the upper portion of the kidney and the adipose capsule, then total adrenalectomy or partial adrenalectomy were selected. The operation time, intraoperative blood loss, postoperative hospitalization, and complications were analyzed. ResultsAll of the 252 cases of operation were succeeded, with no case transferred to open operation, nor received intraoperative or postoperative blood transfusion treatment. For the transperitoneal laparoscopic adrenal surgery group vs retroperitoneal laparoscopic adrenal surgery through intra-adipose capsule approach group, the operation time was (52.7±19.7) min vs (54.4±22.7) min, with no statistical significance; Intraoperative blood loss was (33.1±23.2) ml vs (31.8±21.4) ml, with no statistical significance; The postoperative hospitalization time was (3.5±0.9) d vs (2.8±0.4) d, with retroperitoneal group was shorter significantly. ConclusionsRetroperitoneal laparoscopic adrenal surgery through the intra-adipose capsule approach is a safe and feasible surgical method. It can simplify the surgical procedure and promote the recovery of the patients.