腹腔镜下肾上腺手术对肾上腺肿瘤的疗效及安全性分析

摘要

目的 探讨腹腔镜肾上腺手术对肾上腺肿瘤的治疗效果及其安全性.方法 以2013年3月-2016年3月在该院接受治疗的90例肾上腺肿瘤患者为观察对象.并根据患者意愿分为腹腔镜组(48例)和开腹组(42例),观察两组患者的手术一般情况,比较两组患者术后炎症细胞因子水平、胃肠道积分、并发症和复发率情况.结果 腹腔镜组患者的手术时间、住院时间、肠道功能恢复时间、术后拔管时间和术后引流量均少于开腹组(P<0.05);手术前,两组患者白细胞(WBC)、中性粒细胞比率(NEU%)、C反应蛋白(CRP)和血清白细胞介素-6(IL-6)水平差异无统计学意义,手术后第1、3和5天,两组患者的WBC、NEU%和IL-6水平均有所下降,但腹腔镜组下降更为明显.而两组患者的CRP浓度在手术后第1天均经历一个高峰期,之后的第3天和第5天较术后第1天下降,但都高于手术前,腹腔镜组患者术后各个时段的CRP浓度均低于开腹组(P<0.05);手术后,腹腔镜组患者肠鸣音、腹胀痛和胃肠道反应积分均明显低于开腹组(P<0.05);腹腔镜组术中腹膜损伤发生率和术后腹膜后血肿、切口感染、切口疝和肾上腺皮质功能低下发生率明显低于开腹组(P<0.05),两组术后复发率无明显差别(P>0.05).结论 腹腔镜肾上腺手术术式简单,可减少术中出血量,降低术后并发症发生率,值得在临床推广应用.%Objective To investigate the therapeutic effect and safety of laparoscopic surgery for adrenal tumors. Methods 90 cases of adrenal tumors patients from March 2013 to March 2016 were selected as study subjects and divided into laparoscopic group (48 cases) and open surgery group (42 cases) according to the wishes of the patients. The levels of inflammatory cytokines, gastrointestinal integration, complications and recurrence rate were compared between the two groups. Results The operation time, length of hospital stay, recovery time of bowel function, extubation time and postoperative lead flow rate in laparoscopic group were less than that in the open surgery group (P < 0.05). Before surgery, the level of WBC, NEU%, CPR and IL-6 of the two groups had no significant difference, 1, 3, 5 days after surgery, the level of WBC, NEU and IL-6 groups were all decreased, but the observation group decreased more significantly. The CPR concentrations of the two groups of children in the first day after surgery were experiencing a peak period, after the first 3 days and 5 days which decreased than the first day, but still higher than before the surgery, postoperative group of children CPR concentration of each period were lower than that in control group (P < 0.05). After surgery, patients in the laparoscopic group borborygmus, abdominal pain and gastrointestinal reaction scores were significantly lower than that in laparotomy group (P < 0.05); In the laparoscopic group, the incidence of peritoneal injury and postoperative retroperitoneal hematoma, incision infection, incision hernia and adrenal insufficiency was significantly lower than that in the open group (P < 0.05), there was no significant difference in recurrence rate between the two groups (P > 0.05). Conclusions Laparoscopic adrenal surgery is simple, which can reduce the amount of bleeding and reduce the incidence of postoperative complications, it is worth of promoting clinical application.