经腹膜后腔和经腹腔途径行腹腔镜肾上腺切除术的比较

目的比较经腹腔和经腹膜后腔两种途径的腹腔镜下肾上腺肿瘤切除术的安全性及疗效的差别。 方法回顾性分析2012年3月至2017年12月我院间收治的经腹腔途径（35例）及经腹膜后腔途径（31例）的单侧肾上腺切除手术患者的临床资料，比较两组的曲卡置入时间、手术时间、术中出血量、术后禁食时间、术后引流管留置时间及术后住院天数等临床资料。 结果所有66例手术均于腹腔镜下完成切除，无一例中转开放手术。两组在肾上腺切除手术时间、术后禁食时间等方面差异无统计学意义。但经腹腔组与经腹膜后腔组相比，置曲卡时间、总体手术时间、出血量、术后引流管留置天数及术后住院天数均明显降低。分层分析显示，在肿瘤直径>6 cm时，除了术后引流管留置时间及术后住院天数外，肿瘤切除的手术时间也是经腹腔组短于经腹膜后腔组。 结论两种手术入路的腹腔镜肾上腺切除术皆安全、有效，经腹腔途径建立操作通道时间及总体手术时间更短，对于>6 cm的肿瘤，经腹腔途径在手术时间及安全性方面的优势更明显。

Comparision of laparoscopic adrenalectomy through retroperitoneal and intraperitoneal approach

ObjectiveTo compare the safety and effects of transperitoneal and retroperitoneal laparoscopic for adrenalectomy for adrenal tumor. MethodsThe clinical data of 35 patients underwent unilateral adrenalectomy by transperitoneal laparoscopic adrenalectomy and 31 patients by retroperitoneal laparoscopic adrenalectomy from March 2012 to December 2017 were reviewed in our hospital. The time of trocar insertion, operation time, blood loss, fasting time, drainage time and hospitalization days after operation between the two groups were compared. ResultsOperations was successfully performed in all 66 cases, and no open surgery was converted in any case. Between the transperitoneal and retroperitoneal groups, no significant differences in operating time and post-operation fasting time were found. However, the time of trocar insertion, blood loss, drainage time and the hospitalization days after operation in transperitoneal group were less than those in retroperitoneal group. When the adrenal gland tumor was over 6 cm in diameter, drainage time, the hospitalization days after operation, the time of resection of tumor in transperitoneal group was less than that in groups. ConclusionsThe adrenalectomy for adrenal gland tumor through two approachs are safe and effective. Trocar insertion and total operation time in transperitoneal group may be shorter than in retroperitoneal. The transperitoneal approach has even more advantages in total operating time and safety when the adrenal gland tumor over 6 cm in diameter.