腹腔镜与开放手术切除5~10cm肾上腺肿瘤的回顾性研究

发布时间：2018-07-04 11:16

本文选题：(5～10cm)肾上腺肿瘤 + 后腹腔镜手术　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：回顾性分析我院行手术治疗的最大直径在5～10cm肾上腺肿瘤的患者各项临床资料与指标,比较腹膜后腹腔镜手术与开放手术在治疗直径5-10cm肾上腺肿瘤的优劣势,并评价腹腔镜手术(包括腹膜后入路及经腹腔入路)在治疗大体积肾上腺肿瘤的临床价值及安全性、可行性。方法：收集本院2006年1月至2015年1月期间行手术治疗的直径5～10cm肾上腺肿瘤患者(共88例)的完整临床资料并进行回顾性分析。后腹腔镜手术36例(A组),开放手术46例(B组),经腹腹腔镜手术6例(C组)。统计其平均手术时间、术中平均估计出血量、术中术后血压心率波动情况、术中术后并发症情况、术后平均禁食时间、术后引流管引流时间、术后应用镇痛情况、术后平均住院时间、平均住院总费用等临床资料。同时在后腹腔镜手术组及开放手术组中根据患者体重指数(BMI)、病理诊断结果分为肥胖亚组、嗜铬细胞瘤亚组；并对(A、B)两组总体及亚组病例的临床资料进行对比分析。结果：后腹腔镜手术组与开放手术相比结果如下：后腹腔镜手术36例中2例中转改开放手术。后腹腔镜组在术中平均估计出血量、术中血压心率波动、术后24h镇痛率、术后引流拔除时间、术后平均住院天数及术中术后并发症方面优于开放组,并有统计学差异(P0.05)。而两组在平均手术时间、术中输血例数、术后平均禁食时间、平均住院总费用、血压血钾改善率等方面无统计学差异(P0.05)。在肥胖患者(BMI30)分组中：后腹腔镜组在术中出血量及术后引流时间两方面较开放组有优势(P0.05),而在平均手术时间、术中输血例数、术后切口脂肪液化例数等方面无统计学差异(P0.05)。在嗜铬细胞瘤分组中：后腹腔镜手术组在术中平均估计出血量及术中血压波动率方面较开放组有优势,并有统计学差异(P0.05),而在平均手术时间、术中输血例数、术后转入ICU率及术后血压改善率方面无统计学差异(P0.05)。经腹腔入路腹腔镜手术6例中1例中转开放手术,余均获成功。手术时间106～205min,平均155min；术中估计出血量100-600ml,平均230ml；输血2例；术后禁食时间2-4d,平均2.6d；术后引流管拔除时间4-5d,平均4.8d；术后住院时间4-9d,平均6.6d。术中术后均无明显外科并发症。结论：术前评估及围手术期准备充分、腹腔镜技术娴熟、麻醉技术成熟的前提下腹腔镜手术(包括后腹腔入路及经腹腔入路)治疗直径5～10cm的肾上腺肿瘤是安全可行的,且与开放手术相比具有创伤小、疼痛少,出血少,术后并发症少、恢复快等优势；肿直径介于5-8cm的肾上腺肿瘤且包膜完整、与周围组织器官边界清楚、术者腔镜技术娴熟的可选择后腹腔入路,直径8cm的肾上腺肿瘤则选择经腹腔入路可能有更大优势。
[Abstract]:Objective: To review the clinical data and indexes of the patients with the maximum diameter of 5 ~ 10cm adrenal tumors in our hospital, compare the advantages and disadvantages of retroperitoneal laparoscopic surgery and open surgery in the treatment of 5-10cm adrenal tumors, and evaluate the laparoscopic operation (including retroperitoneal approach and transperitoneal approach) in the general treatment of the adrenal tumor. The clinical value and safety of adrenal tumor and its feasibility. Methods: the complete clinical data of 5 ~ 10cm adrenal tumors (88 cases) in diameter from January 2006 to January 2015 were collected and analyzed retrospectively. 36 cases (group A), 46 cases of open surgery (group B), and 6 cases of abdominal laparoscopy (C The average operation time, intraoperative mean estimated bleeding, postoperative blood pressure and heart rate fluctuation, postoperative complications, postoperative average fasting time, postoperative drainage tube drainage time, postoperative analgesia, average hospitalization time after operation, average total hospitalization expenses and other clinical data. In the open operation group, according to the patient's body mass index (BMI), the pathological diagnosis was divided into obesity subgroup and pheochromocytoma subgroup, and the clinical data of two groups and subgroups of (A, B) were compared and analyzed. Results: the results of the retroperitoneal laparoscopic operation group and the open operation were compared with the open operation in 36 cases, 2 cases were converted to open surgery. The average amount of bleeding, the fluctuation of blood pressure and heart rate, the postoperative 24h analgesic rate, the postoperative drainage time, the average days of hospitalization and the postoperative complications were better than those in the open group (P0.05). The two groups were in the average operation time, the average time of postoperative fasting, and the average time. There was no significant difference in total hospital cost, blood pressure and blood potassium improvement rate (P0.05). In the group of obese patients (BMI30), there were two advantages (P0.05) in the amount of intraoperative bleeding and the postoperative drainage time in the post laparoscopic group (P0.05), but there was no significant difference in the average operation time, the number of intraoperative blood transfusions, and the number of postoperative incision fat liquefaction (P0 .05). In the pheochromocytoma grouping: the average estimated bleeding volume and the intraoperative blood pressure fluctuation in the postlaparoscopic operation group were superior to those in the open group, and there were statistical differences (P0.05). There was no statistical difference between the average operation time, the number of intraoperative blood transfusions, the rate of ICU and the improvement of blood pressure after operation (P0.05). Of the 6 cases of laparoscopic surgery, 1 cases were transferred to the open operation. The operation time was 106 ~ 205min, average 155min, the amount of bleeding was 100-600ml, the average 230ml, the blood transfusion was 2 cases, the time of the postoperative fasting was 2-4d, the average 2.6d; the drainage time was 4-5d, the average 4.8d, the postoperative hospital time was 4-9d, and the mean 6.6d. operation was not clear. Surgical complications. Conclusions: preoperative assessment and perioperative period preparation, laparoscopic technique and mature anesthesia, laparoscopic surgery (including retroperitoneal approach and transperitoneal approach) are safe and feasible for the treatment of adrenal tumors with a diameter of 5 to 10cm, and are less traumatic, less painful, less bleeding, and less bleeding than open surgery. There are fewer complications and faster recovery. The adrenal tumors with a diameter of 5-8cm are adrenal tumors with a complete envelope, clear boundaries with the surrounding tissues and organs, and the surgeons have a skilled and skilled posterior intraperitoneal approach. The diameter of the adrenal tumor with a diameter of 8cm may have a greater advantage.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R736.6

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