腹腔镜经腰腹联合途径行较大肾上腺肿瘤切除的临床研究

目的 研究腹腔镜新的手术路径——经腰腹联合途径切除较大肾上腺肿瘤的临床安全性和有效性。方法 直径≥6.0 cm的肾上腺肿瘤分别采用经腹腹腔镜(n=30)和腹腔镜经腰腹联合途径(n=30)行肾上腺肿瘤切除。收集并比较两组间基本资料、手术中数据、手术后数据和随访资料。结果 两组患者基本情况相似，基线相同。两种不同入路的手术方式的中转开放率、估计出血量、输血率、手术时间、副损伤、血压心率波动和术中心脑血管并发症等术中指标，两组间差异无统计学意义（P>0.05）；术后引流量、拔除引流管时间、术后住院时间、术后镇痛药物使用、发热、感染、肠梗阻和其他术后并发症等术后指标，两组间差异无统计学意义（P>0.05）。经腰腹联合入路组在肠功能恢复开始进食时间和开始下床活动时间略有优势，但两组差异仍无统计学意义（P>0.05）。两种不同入路的手术方式的肿瘤手术后期治疗方式、肿瘤复发率、转移率和生存率等术后随访指标，两组间差异无统计学意义（P>0.05）。结论 经腹膜后而又完全打开侧腹膜的腹腔镜经腰腹联合途径行较大肾上腺肿瘤切除安全有效，具有临床推广的价值。

Trans-lumbar-and-peritoneally Joint Approach for Laparoscopic Removal of Large Adrenal Neoplasms

Objective To explore the safety and efficacy of trans-lumbar-and-peritoneally joint (TLPJ) approach for laparoscopic dissection of large neoplasms from adrenal glands. Methods Sixty patients with diameters ≥ 6.0 cm adrenal neoplasms were recruited in this study. Of the participants, 30 were given transperitoneally laparoscopic adenectomy and 30 were given TLPJ approach. We compared the basic characteristics of the patients, as well as their conditions during and after operations. Results The two groups of patients had similar characteristics. No significant differences were found between the two approaches in terms of conversion to open surgery, estimated blood loss, transfusion, operating time, side injury, fluctuations of heart rate and blood pressure, and vascular accidents (P>0.05), although slight, but not significant, advantages were shown in the TLPJ patients on starting food intake and physical activities. Similar results were also found in drainage volume, time to remove drainage, length of hospital stay, usage of analgesic, fever incidence, infection and intestinal obstruction etc (P>0.05). Above all, no significant differences were found between the two groups in recurrence, metastasis and overall survival rates (P>0.05). Conclusion Laparoscopic surgery with TLPJ approach, translumbar combined with entirely side peritoneum opened, is safe and efficient compared with the traditional transperitoneal approach for patients with large adrenal neoplasms.