Hou Qian, Zhang Biao, Luo Yao, Wang Pengyuan, Yang Shujun, Shang Panfeng
Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
J Laparoendosc Adv Surg Tech A. 2023 Jan;33(1):38-43. doi: 10.1089/lap.2022.0196. Epub 2022 May 26.
With the development of minimally invasive techniques, laparoscopic adrenalectomy (LA) has become the standard for the treatment of adrenal surgical diseases, but conversion to open adrenalectomy (OA) is also necessary in some cases. The purpose of this study was to investigate the risk factors for conversion from LA to OA. A retrospective study was performed on 911 patients who were diagnosed with adrenal tumors and underwent LA in the Department of Urology, Second Hospital of Lanzhou University from January 2013 to December 2021. According to the surgical methods, the patients were divided into the laparoscopic group ( = 873) and the conversion group ( = 38). Logistic regression was used to analyze the independent risk factors of conversion, and the logistic regression equation was established to predict the probability of conversion. In this study, 38 patients (4.17%) were converted to open. In the univariate analysis, body mass index ( = .037), tumor side ( < .001), tumor size ( < .001), surgical approach ( < .001), and histological type ( = .006) were significantly associated with conversion. In the multivariate analysis, tumor diameter >7 cm (odds ratio = 2.835, 95% confidence interval 1.096-7.335; = .032), transabdominal approach (odds ratio = 2.400, 95% confidence interval 1.136-5.074; = .022), pheochromocytoma (odds ratio = 5.018, 95% confidence interval 1.964-12.822; = .001), and malignant tumor (odds ratio = 17.781, 95% confidence interval 4.156-76.075; < .001) were independent risk factors for transition opening. The logistic regression equation showed good power to predict conversion. Tumor size, surgical approach, and histological type were predictive factors for conversion from a laparoscopic to an open procedure. Preoperative evaluation of these characteristics is of great value for clinicians to evaluate the risk of conversion and make a surgical plan. It can not only reduce the conversion rate but also help to improve the intraoperative situation and shorten the length of hospital stays.
随着微创技术的发展，腹腔镜肾上腺切除术（LA）已成为肾上腺外科疾病治疗的标准术式，但在某些情况下转为开放性肾上腺切除术（OA）也是必要的。本研究旨在探讨LA转为OA的危险因素。对2013年1月至2021年12月在兰州大学第二医院泌尿外科诊断为肾上腺肿瘤并接受LA的911例患者进行回顾性研究。根据手术方式，将患者分为腹腔镜组（n = 873）和中转组（n = 38）。采用Logistic回归分析中转的独立危险因素，并建立Logistic回归方程预测中转概率。本研究中，38例患者（4.17%）转为开放手术。单因素分析中，体重指数（P = .037）、肿瘤侧别（P < .001）、肿瘤大小（P < .001）、手术入路（P < .001）和组织学类型（P = .006）与中转显著相关。多因素分析中，肿瘤直径>7 cm（比值比 = 2.835，95%置信区间1.096 - 7.335；P = .032）、经腹入路（比值比 = 2.400，95%置信区间1.136 - 5.074；P = .022）、嗜铬细胞瘤（比值比 = 5.018，95%置信区间1.964 - 12.822；P = .001）和恶性肿瘤（比值比 = 17.781，95%置信区间4.156 - 76.075；P < .001）是中转开放手术的独立危险因素。Logistic回归方程显示出良好的预测中转能力。肿瘤大小、手术入路和组织学类型是腹腔镜手术转为开放手术的预测因素。术前评估这些特征对于临床医生评估中转风险和制定手术方案具有重要价值。它不仅可以降低中转率，还有助于改善术中情况并缩短住院时间。
