486例肾上腺疾病外科治疗的回顾性分析

目的 总结腹腔镜手术与开放手术在肾上腺疾病外科治疗中的临床经验.方法 回顾性分析486例肾上腺疾病患者的临床资料,其中478例行手术治疗,包括开放手术组318例和腹腔镜手术组160例.比较两组手术时间、术中出血量、术后肠功能恢复时间、术后疼痛、术后住院天数及手术并发症等方面的差异.结果 开放手术组手术全部成功;腹腔镜手术组154例成功,6例中转开放后成功切除肿瘤.腹腔镜手术组切除肿瘤直径＞6 cm者9例,恶性肿瘤3例,随访3～20个月无复发或转移.两组平均手术时间分别为(112±16)min、(69±10)min,术中平均出血量分别为(286±23)ml、(56±10)ml,术后平均肠功能恢复时间分别为(66±7)h、(24±7)h,术后平均镇痛次数分别为(1.9±0.4)次、(0.5±0.1)次,平均住院天数分别为(10.3±1.1)d、(7.2±0.7)d,并发症发生率分别为40.3%、7.5%,差异有统计学意义(P=0.023,0.007,0.039,O.003,0.029,0.001).结论 腹腔镜肾上腺切除术在手术时间、术中出血量、术后肠功能恢复时间、术后痛疼、住院天数以及并发症发生率等方面均优于传统的开放手术,已成为大部分良性肾上腺疾病治疗的金标准,但在大体积和恶性肿瘤的治疗中仍存在一些限制,正确地选择手术适应证和完善的围手术处理至关重要.

Surgical treatment of 486 cases of adrenal gland diseases: a retrospective study

OBJECTIVE: To evaluate the roles of laparoscopic adrenalectomy (LA) and open adrenalectomy (GA) for treatment of adrenal gland diseases. METHODS: The data of 486 patients with adrenal gland diseases was analyzed retrospectively during 5 years. A total of 478 patients received surgical treatments including 318 GAs and 160 LAs. The operation time, bleeding volume during operation, intestine function recovery time, pain postoperatively, hospital stay time postoperatively and postoperative complications in group GA and group LA respectively were compared. RESULTS: All cases in group GA were successful. A total of 154 cases in group LA were successful, and 6 cases were converted to open surgery. In group LA, there were 9 cases whose tumor diameter exceeded 6 cm. There were 3 malignant cases in group LA, and no recurrence and metastasis were observed during 3-20 months follow-up. The average operation time was (112 +/- 16) mmn and (69 +/- 10) min in group GA and LA respectively. The average bleeding volume during operation was (286 +/- 23) ml, (56 +/- 10) ml in group GA and LA respectively. The average intestine function recovery time was (66 +/- 7) h, (24 +/- 7) h in group GA and LA respectively. The average frequency of treatment of pain was 1.9 +/- 0.4 and 0.5 +/- 0.1 in group GA and LA respectively. The average hospital stay time postoperatively was (10.3 +/- 1.1) d and (7.2 +/- 0.7) d in group GA and LA respectively. The rate of postoperative complications was 40.3% and 7.5% in group GA and LA respectively. All differences were significant (P = 0.023, 0.007, 0.039, 0.003, 0.029 and 0.001). CONCLUSIONS: LA has the added benefit of shorter convalescent times, improving patients satisfaction and less associated complications, as it has proved to be as effective as OA.