经腹单孔多通道腹腔镜与标准腹腔镜肾上腺切除术对比研究

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摘要 目的:探讨经腹单孔腹腔镜肾上腺切除术的可行性,安全性和有效性,并与标准经腹腹腔镜肾上腺切除术对照分析,评价其临床优势。方法:对经腹单孔腹腔镜肾上腺切除术13例和标准经腹腹腔镜肾上腺切除术26例患者的临床资料和随访资料进行统计学分析。结果:两组患者在基线水平,术中出血,术后住院时间方面差异无统计学意义。单孔腹腔镜手术组手术时间较标准腹腔镜手术组长(148.5∶112.9 min, P=0.032),但在术后疼痛评分(2.3∶3.7, P=0.001)、术后需阿片类镇痛药人数比例(30.8%∶73.1%, P=0.011)、术后进食时间(21.6∶26.0 h, P=0.002)、皮肤切口长度(2.3∶5.9 cm, P<0.001)及满意度方面(9.5∶9.1, P=0.042),单孔腹腔镜手术组患者均优于标准腹腔镜手术组患者。术后第1年随访结束时,两组患者均无肿瘤复发,且无药物无法控制的症状。结论:经腹单孔腹腔镜肾上腺切除术安全、可行、有效,且与标准腹腔镜肾上腺切除术相比,尽管手术时间略长,但具有患者术后疼痛轻,镇痛药物需要量少,肠道通气快,皮肤切口小及满意度高的优点。

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	刘冰
	王林辉
	纪家涛
	王富博
	吴震杰
	宋尚卿
	肖成武
	李耀明
	杨庆
	孙颖浩

关键词 ：单孔腹腔镜手术, 标准腹腔镜手术, 肾上腺切除术

Abstract：Objective:To evaluate the feasibility, safety, and efficacy of transperitoneal laparoendoscopic single-site (LESS) adrenalectomy and seek to whether it indicates advantages compared with standard laparoscopy.Methods:Between August 2009 and May 2011, a single urologist in our center performed 13 cases of transperitoneal LESS adrenalectomy through a 2-3 cm skin incision using the TriPort access system and 26 cases of standard laparoscopic adrenalectomy. The clinical and follow-up data were statistically analyzed.Results:The 2 groups were compared with respect to patient demographics, estimated blood loss, and postoperative hospitalization (P＞0.05). The LESS procedures had a longer mean operative time (148.5∶112.9 mins, P=0.032), but a significantly lower postoperative visual analog pain scale score (2.3 ∶ 3.7, P=0.001), fewer patients requiring analgesics (30.8% ∶ 73.1%, P=0.011), and an earlier resumption of oral intake (21.6 ∶ 26.0 hours, P=0.002). The mean length of the scar in the LESS group was much smaller (2.3 ∶ 5.9 cm, P<0.001) with a statistically significant greater mean cosmetic satisfaction score (9.5 ∶ 9.1, P=0.042).Conclusions:The transperitoneal LESS adrenalectomy provides better postoperative pain control, faster recovery of bowel function, and better cosmetic satisfaction than standard laparoscopy, albeit with a longer operative time. It is a feasible, safe, and effective option for small adrenal tumors.

Key words： laparoendoscopic single-site surgery standard laparoscopic surgery adrenalectomy

收稿日期: 2012-10-18

ZTFLH:

R699.3

基金资助:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115) 军队临床高新技术重大项目(2010gxjs057)

通讯作者: 孙颖浩,sunyh@medmail.com.cn

作者简介: ^△共同第一作者

引用本文:

刘冰, 王林辉, 纪家涛, 王富博, 吴震杰, 宋尚卿, 肖成武, 李耀明, 杨庆, 孙颖浩. 经腹单孔多通道腹腔镜与标准腹腔镜肾上腺切除术对比研究[J]. 微创泌尿外科杂志, 2013, 2(2): 100-103.
Liu Bing, Wang Linhui, Ji Jiatao, Wang Fubo, Wu Zhengjie, Song Shangqing, Xiao Chengwu, Li Yaoming, Yang Qing, Sun Yinghao. Comparison of transperitoneal laparoendoscopic single-site surgery and standard laparoscopic adrenalectomy. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2013, 2(2): 100-103.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract986.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2013/V2/I2/100

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