后腹腔镜下改良单层面法与传统三层面法肾上腺肿物切除术的临床比较

李建; 李庆文; 刘建民; 王成勇; 陈志军; 薛胜; 汪盛; 方习武; 刘贝贝

doi:10.13898/j.cnki.issn.1000-2200.2019.09.023

后腹腔镜下改良单层面法与传统三层面法肾上腺肿物切除术的临床比较

Clinical comparison between retroperitoneal laparoscopic modified single-layer adrenalectomy and traditional three-layer adrenalectomy in adrenal mass resection

摘要

摘要:
目的比较后腹腔镜改良单层面分离法与传统三层面分离法肾上腺肿物切除术的临床效果。
方法选择肾上腺肿物病人43例，随机分成2组，观察组22例，行经后腹腔镜改良单层面肾上腺肿物切除术，从背侧腰大肌表面的疏松无血管平面一直向上向内游离直至找到肾上腺中央静脉，处理中央静脉后，快速切除肾上腺；对照组21例，行经后腹腔镜传统三平面法肾上腺肿物切除术。对比2组病人总手术时间、找到肾上腺中央静脉时间、术中出血量、拔除引流管时间、住院时间。
结果43例行经后腹腔肾上腺肿物切除术均获成功，无中转开放手术。观察组总手术时间、找到肾上腺中央静脉时间、术中出血量及术后住院时间均小于对照组（P < 0.05~P < 0.01）。2组去除引流管时间差异无统计学意义（P>0.05）。2组均无严重并发症发生。
结论2种手术方法均具有安全性、有效性。后腹腔镜改良单层面肾上腺肿瘤切除术能够早期快速寻找并处理肾上腺中央静脉，解剖层次清晰。

Abstract:
ObjectiveTo compare the clinical effects between retroperitoneal laparoscopic modified single-layer adrenalectomy and traditional three-layer adrenalectomy in adrenal mass resection.
MethodsForty-three patients with adrenal masses were randomly divided into the observation group(22 cases) and control group(21 cases).The observation group was treated with retroperitoneal laparoscopic modified single-layer adrenalectomy.The adrenal central vein was found from the loose and no blood vessel plane of the dorsal psoas major, and the adrenal gland was quickly removed after the central vein was treated.The control group was treated with retroperitoneal laparoscopic conventional three-layer adrenalectomy.The total operation time, time of finding central adrenal vein, amount of intraoperative blood loss, time of removing drainage tube and length of hospital stay were compared between two groups.
ResultsThe retroperitoneal adrenalectomy in 43 cases with adrenal mass were successful, and no open surgery was performed.The total operation time, time of finding central adrenal vein, amount of intraoperative blood loss and length of hospital stay in observation group were less than those in control group(P < 0.05 to P < 0.01).The difference of the time of removing drainage tube between two groups was not statistically significant(P>0.05), and no serious complications occurred in two groups.
ConclusionsBoth surgical methods are safe and effective.The retroperitoneal laparoscopic modified single-layer adrenalectomy can quickly find and treat the adrenal central vein in the early stage, and the anatomical layer is clear.

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