不同入路机器人辅助腹腔镜手术治疗小体积肾上腺腺瘤

doi:10.3877/cma.j.issn.1674-6899.2021.06.008

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (06): 359 -362. doi: 10.3877/cma.j.issn.1674-6899.2021.06.008

韩毅力¹, 赵佳晖¹, 罗勇¹, 李明川¹, 魏德超¹, 姜永光¹^,^†(

)

^1. 100029　北京，首都医科大学附属北京安贞医院泌尿外科

收稿日期:2021-09-09 出版日期:2021-12-30
通信作者: 姜永光

Robot assisted laparoscopic surgery for small adrenal adenomas with different access

Yili Han¹, Jiahui Zhao¹, Yong Luo¹, Mingchuan Li¹, Dechao Wei¹, Yongguang Jiang¹^,^†()

^1. Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

Received:2021-09-09 Published:2021-12-30
Corresponding author: Yongguang Jiang

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目的

通过经腹腔肾上腺切除术(robot-assisted transperitoneal adrenalectomy, RATA)与腹膜后肾上腺切除术(robot-assisted retroperitoneal adrenalectomy, RARA)两种入路机器人辅助腹腔镜手术治疗小体积肾上腺腺瘤，并进行比较。

方法

回顾性分析2017年1月至2019年12月期间，首都医科大学附属北京安贞医院泌尿外科机器人手术治疗肾上腺腺瘤患者的28例临床资料。

结果

28例患者中，6例行RATA、22例行RARA。所有患者均未中转手术。病理证实均为肾上腺皮质腺瘤。RARA和RATA在术后引流时间方面无明显差异[(2.1±0.5)d比(2.3±0.8)d]。同RATA比较，RARA的手术时间短[(72±19)min比(109±25)min]、术中出血量少[(47±15)ml比(84±26)ml]、术后首次进食时间早[(1.2±0.8)d比(2.4±1.3)d]、术后住院时间短[(4.5±1.6)d比(7.5±1.9)d]，差异有统计学意义(P<0.05)。

结论

在小体积肾上腺腺瘤的治疗上，RARA可能优于RATA。

关键词: 肾上腺腺瘤, 机器人辅助腹腔镜肾上腺切除术, 腹腔入路, 腹膜后入路

Objectives

To compare robot assisted laparoscopic transperitoneal and retroperitoneal operation for small adrenal adenomas.

Methods

The clinical data were analyzed retrospectively in 28 patients with adrenal adenoma who underwent robotic surgery via retroperitoneal and transperitoneal approaches in Beijing Anzhen Hospital from Jan. 2017 to Dec. 2019.

Results

6 in 28 cases were operated with transperitoneal access and 22 cases with retroperitoneal access. All patients were not converted to opening operations and proved to be adrenal cortical adenoma by pathology. There was no significant difference in postoperative drainage time between retroperitoneal and transperitoneal approaches (2.1±0.5)d vs (2.3±0.8)d. Retroperitoneal approach was better than transperitoneal approach in operation time (72±19)min vs (109±25)min, blood loss (47±15)ml vs (84±26)ml, early postoperative feeding (1.2±0.8)d vs (2.4±1.3)d and postoperative hospital stay (4.5±1.6)d vs (7.5±1.9)d, statistic differences were significant (P<0.05).

Conclusions

Robot-assisted retroperitoneal adrenalectomy may be superior to transperitoneal approach for small adrenal adenomas.

Key words: Adrenal adenoma, Robot-assisted laparoscopic adrenalectomy, Transperitoneal, Retroperitoneal

图1 不同手术入路肾上腺切除术的Trocar布局注：A.机器人辅助腹膜后肾上腺切除术的Trocar布局；B.机器人辅助经腹腔肾上腺切除术的Trocar布局

表1 两组肾上腺切除术患者的围手术期比较(±s)

分组	例数	手术时间(min)	术中出血量(ml)	术后住院时间(d)	术后首次进食时间(d)	术后引流时间(d)
RARA组	22	72±19	47±15	4.5±1.6	1.2±0.8	2.1±0.5
RATA组	6	109±25	84±26	7.5±1.9	2.4±1.3	2.3±0.8
t值		4.572	7.449	6.985	3.623	1.781
P值		<0.01	<0.01	<0.01	<0.01	0.20

表1 两组肾上腺切除术患者的围手术期比较(±s)

分组	例数	手术时间(min)	术中出血量(ml)	术后住院时间(d)	术后首次进食时间(d)	术后引流时间(d)
RARA组	22	72±19	47±15	4.5±1.6	1.2±0.8	2.1±0.5
RATA组	6	109±25	84±26	7.5±1.9	2.4±1.3	2.3±0.8
t值		4.572	7.449	6.985	3.623	1.781
P值		<0.01	<0.01	<0.01	<0.01	0.20

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[2]	陈世超, 王凯, 王作伟, 吴浩. 经外侧腹膜后入路显微手术治疗腰椎椎旁肿瘤[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(06): 366-369.

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