Chen Wei, Lin Wei, Han Deng-Jun, Liang Yong
Department of Urology, Zigong Fourth People's Hospital, Sichuan, China, 643000.
Afr Health Sci. 2017 Mar;17(1):293-300. doi: 10.4314/ahs.v17i1.36.
The role of lateral retroperitoneoscopic adrenalectomy (LRA) for complicated tumor with large diameter remains controversial, this study aimed to evaluate the effectiveness of this procedure on the management of tumor larger than 5cm in diameter.
A retrospective comparison was conducted of 67 patients with large complicated adrenal tumor (>5cm). 41 patients received LRA, and 26 received open adrenalectomy (OA) in our hospital between January 2011 and June 2015. Basic characteristics regarding mean age, gender, body mass index (BMI), tumor size, tumor side, previous abdominal surgery, resection method, pathology were preferentially analyzed. Operative indicators regarding operation time, estimated blood loss (EBL), conversion to ICU, complications, post-operative hospitalization, duration of drain, time to first oral intake and ambulation were compared between groups.
There were no significant differences between the two groups in the basic characteristics. The mean operation time for LRA was shorter than OA (98.7±32.3 min vs 152.7±72.3 min, P = 0.001). EBL was 31.9±20.0 ml for LRA and 590.0±1181.1 ml for OA (P = 0.03). There was no complication in LRA group and one patient in OA group had complications, but this difference was not significant (P = NS). The post-operative hospitalization in LRA was 7.4±2.8 days, and shorter than 9.8±2.7 days in OA group (P = 0.00). The time to first oral intake and ambulation for LRA was shorter than OA (first oral intake, 1.9±0.8 days vs 3.1±1.3 days, P = 0.00; time to ambulation, 2.6±1.4 days vs 4.2±1.6 days, P = 0.00). While the difference between groups were not significant in terms of ICU conversion (3/41 vs 4/26, P = NS) and duration of drain (3.9±2.2 days vs 4.7±1.9 days, P = NS).
Our study shows that LRA can be performed safely and effectively for complicated adrenal tumors larger than 5 cm in diameter, but it remains technically demanding.
侧卧位后腹腔镜肾上腺切除术（LRA）治疗直径较大的复杂肿瘤的作用仍存在争议，本研究旨在评估该手术治疗直径大于5cm肿瘤的有效性。
对67例直径大于5cm的复杂肾上腺肿瘤患者进行回顾性比较。2011年1月至2015年6月期间，我院41例患者接受了LRA，26例接受了开放性肾上腺切除术（OA）。优先分析了平均年龄、性别、体重指数（BMI）、肿瘤大小、肿瘤侧别、既往腹部手术史、切除方法、病理等基本特征。比较两组患者的手术时间、估计失血量（EBL）、转入重症监护病房情况、并发症、术后住院时间、引流时间、首次经口进食时间和下床活动时间等手术指标。
两组患者的基本特征无显著差异。LRA的平均手术时间短于OA（98.7±32.3分钟对152.7±72.3分钟，P = 0.001）。LRA的EBL为31.9±20.0毫升，OA为590.0±1181.1毫升（P = 0.03）。LRA组无并发症，OA组有1例患者出现并发症，但差异无统计学意义（P = NS）。LRA术后住院时间为7.4±2.8天，短于OA组的9.8±2.7天（P = 0.00）。LRA的首次经口进食时间和下床活动时间短于OA（首次经口进食，1.9±0.8天对3.1±1.3天，P = 0.00；下床活动时间，2.6±1.4天对4.2±1.6天，P = 0.00）。而两组在转入重症监护病房情况（3/41对4/26，P = NS）和引流时间（3.9±2.2天对4.7±1.9天，P = NS）方面差异无统计学意义。
我们的研究表明，LRA可安全有效地用于治疗直径大于5cm的复杂肾上腺肿瘤，但技术要求仍然较高。
