【作者】 董伟平；

【导师】 吕家驹；

【作者基本信息】 山东大学 ， 泌尿外科， 2010， 硕士

【摘要】 目的：评价和比较肾上腺肿瘤三种手术方式(A.后腹腔镜B.腹腔镜C.开放手术)的临床应用。方法：收集山东省立医院泌尿外科2007年1月～2009年11月肾上腺肿瘤病例共116例,其中后腹腔镜手术32例,腹腔镜手术42例,开放手术42例。分别设为A组、B组和C组,总结上述病例相关资料,统计分析上述三种手术方式平均手术时间,术中输血情况,术后总引流量,术后入住ICU情况,肠道功能平均恢复时间,术后住院时间,肿瘤良、恶性情况等差异。结果：后腹腔镜组32例手术全部成功,腹腔镜组42例手术全部成功,开放手术组42例手术全部成功。三组手术时间分别为127.5±41.8 min和117.9±54.9 min,87.4±35.3 min；术后住院天数分别为：6.5±3.3 d、7.8±4.2 d,9.4±2.8 d；术中输血情况：后腹腔镜手术组中无术中输血者,腹腔镜组中3例术中给予输血,开放手术组中13例术中给予输血；肠道功能平均恢复时间分别为：2.4±1.0 d、2.5±1.3 d,3.4±1.1d；术后拔管时间分别为：2.7±1.46d、4.7±2.2d、3.1±0.95d；术后引流量：91.0±83.1 ml、206.5±147.3 ml、90.9±57.6 ml；肿瘤大小(CT)：1.9±0.9cm、2.2±1.0cm、4.7±2.3cm；肿瘤大小(B超)：2.1±0.9cm、2.7±2.0cm、5.1±2.9cm；三组术后入住ICU情况分别为：0,7例,4例；肿瘤良恶性情况：后腹腔组、经腹腔组术后病理报告均为良性。开放手术组中共有5例病理报告为恶性。后腹腔镜组、经腹腔组、开放手术组术后均无明显并发症发生。结论：肾上腺肿瘤手术治疗应该依据肿瘤的大小、性质等选择手术方式。对于直径大于6cm的肿瘤或者术前怀疑为恶性肿瘤者,开放手术更为合适。直径小于6cm的良性肿瘤更倾向于腹腔镜手术治疗。腹腔镜肾上腺切除术在术后住院天数、肠道平均恢复时间、术中输血比例、和术后引流量等方面数据与开放手术相关项目比较具有明显优势(P<0.05)。后腹腔镜在术后住院天数、术后引流量等方面明显优于腹腔镜(P<0.05),其余相关数据比较两者差异不大,无统计学意义,因此认为可将后腹腔镜作为肾上腺良性肿瘤外科治疗的首选方法,特别是小的肾上腺良性肿瘤。更多还原

【Abstract】 Objective:To research the clinical application of three different procedures (posterior laparoscopic Adrenalectomy, transperitoneal laparoscopic Adrenalectomy, open Adrenalectomy) of Adrenalectomy。Method:The collected 116 cases of adrenalectomy from January 2007 to November 2009 in Shandong Provincial Hospital were analyzed, The 32 cases of retroperitoneal laparoscopic adrenalectomy,the 42 cases of transperitonal laparoscopic and the 42 cases of open adrenalectomy were classified Group A,Group B and Group C.The differences in operation time, blood-transfusion, the postoperative drainage volume, the ICU length stay after operation, and recovery time of GI function, hospitalization stay after operation, the histopathologic features,these date of the three procedures were compared with statistical analysis.Result:All the 116 cases of Adrenalectomy were successful.The mean operating time:group A was 127.5±41.8 min; group B was 117.9±54.9 min;group C was 87.4±35.3 min; the hospitalization stay after operation:group A was 6.5±3.3 d; group B was 7.8±4.2 d; group C was 9.4±2.8 d; the blood-transfusion:group A was none; group B was 3;group C was 13; the mean revovery time of G1 function: group A was 2.4±1.0 d; group B was 2.5±1.3 d;group C was 3.4±1.1 d;the mean postoperative drainage volume:group A was 91.0±83.1 ml; group B was 206.5±147.3 ml;group C was 90.9±57.6 ml;the size of tumor (CT):group A was 1.9±0.9cm; group B was 2.2±1.0cm; group C was 4.7±2.3cm; the size of tumor (US): 2.1±0.9cm; group B was 2.7±2.0cm; group C wsa 5.1±2.9cm; the histopathologic features:All the cease in group A and group were benign tumour; 5 cases of group C were malignant tumor; there were no obvious complication happened in all the cases.Conclusions:In adrenalcetomy, the slection of operation menthods should be according to the tumor size, pathological character and positon. For patients with larger tumors (>6cm) or malignant tumor diagnosised before operations。open operation was a good choose.The other patients with benign tumour and small tumors size (<6cm), the laparoscopic adrenalectomy should be performed. Laparoscopic adrenalectomy have advantages in hospitalization stay after operation, recovery time of GI function, the less blood-transfusion and the mean postoperative drainage volume than open operation (P<0.05). Retroperitoneal laparoscopic adrenalectomy is safe, effective procedure and contains all the advantages of minimally invasive surgery, less traumatic, less hospitalization stay after operation,less blood-transfusion and quicker recovery time. It should be considered as the first choice of therapy for most adrenal disorders, especially for small adrenal benign tumor (<6cm).更多还原