精準(zhǔn)解剖性后腹腔鏡技術(shù)在腎上腺腫瘤切除術(shù)中的臨床應(yīng)用研究

王蘇貴　李強(qiáng)　吳自余　姜福金　張先云

[摘要]目的 探討精準(zhǔn)解剖性后腹腔鏡技術(shù)在腎上腺腫瘤切除術(shù)中的臨床應(yīng)用價(jià)值。方法 選取2016年1月～2019年6月徐州醫(yī)科大學(xué)附屬淮安醫(yī)院泌尿外科的40例腎上腺腫瘤患者，采用隨機(jī)數(shù)字表法分為實(shí)驗(yàn)組與對(duì)照組，各20例。實(shí)驗(yàn)組采用精準(zhǔn)解剖性后腹腔鏡技術(shù)行無血管層面準(zhǔn)確分離及腎上腺腫瘤切除術(shù)，對(duì)照組采用傳統(tǒng)的后腹腔鏡技術(shù)行腎上腺腫瘤切除術(shù)。比較兩組患者的手術(shù)時(shí)間、術(shù)中出血量、手術(shù)并發(fā)癥、術(shù)后引流管留置時(shí)間及術(shù)后住院時(shí)間等指標(biāo)。結(jié)果? 40例患者手術(shù)均獲得成功，無中轉(zhuǎn)開放手術(shù)，術(shù)中無明顯并發(fā)癥發(fā)生。實(shí)驗(yàn)組的手術(shù)時(shí)間明顯短于對(duì)照組，且術(shù)中出血明顯少于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;兩組的術(shù)后并發(fā)癥發(fā)生率、術(shù)后引流管留置時(shí)間及術(shù)后住院時(shí)間比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 精準(zhǔn)解剖性后腹腔鏡技術(shù)在腎上腺腫瘤切除術(shù)中安全可靠、療效確切、創(chuàng)傷小，值得臨床廣泛推廣。

[關(guān)鍵詞]腎上腺腫瘤;后腹腔鏡;精準(zhǔn)外科

[中圖分類號(hào)] R737.11? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721（2020）6（c）-0050-03

Clinical application study of precise anatomical retroperitoneal laparoscopic technique in adrenal tumorectomy

WANG Su-gui? ?LI Qiang? ?WU Zi-yu▲? ?JIANG Fu-jin? ?ZHANG Xian-yun

Department of Urology Surgery， Huai′an Hospital Affiliated of Xuzhou Medical College， the Second People′s Hospital of Huai′an City in Jiangsu Province， Huai′an? ?223002， China

[Abstract] Objective To explore the clinical application value of precise anatomical retroperitoneal laparoscopic technique in adrenal tumorectomy. Methods From January 2016 to June 2019， 40 patients with adrenal tumor from the Urology Department of Huai′an Hospital Affiliated to Xuzhou Medical College were selected. They were divided into the experimental group and the control group according to a random number table method， 20 cases in each group. In the experimental group， the precise anatomical retroperitoneal laparoscopic technique was used for accurate separation of non vascular layer and adrenalectomy. In the control group， adrenal tumorectomy with traditional retroperitoneal laparoscopic technique was given. The operative time， intraoperative bleeding volume， operative complications， postoperative drainage tube retention time and postoperative hospital stay time were compared between the two groups. Results The operation time of the experimental group was significantly shorter than that of the control group， and the intraoperative bleeding of the experimental group was significantly less than that of the control group， the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in the incidence of postoperative complications， the postoperative drainage tube retention time and the postoperative hospital stay time （P>0.05）. Conclusion Precise anatomical retroperitoneal laparoscopic technique in adrenal tumorectomy is safe， reliable， effective and minimally invasive， which is worth popularizing in clinic.

[Key words] Adrenal tumors; Retroperitoneal laparoscope; Precise surgery

隨著現(xiàn)代外科學(xué)的不斷發(fā)展以及外科理念的不斷進(jìn)步與改善，精準(zhǔn)外科理念不斷被應(yīng)用于各個(gè)專科。精準(zhǔn)外科理念的精髓就是將病灶的切除、臟器的保護(hù)以及損傷的控制這三者達(dá)到最大的優(yōu)化，使患者在微創(chuàng)手術(shù)中更高效地獲益[1]。在我國泌尿外科領(lǐng)域，經(jīng)腹膜后途經(jīng)的后腹腔鏡手術(shù)已逐漸地被廣泛開展起來，且在處理腎上腺腫瘤等腎上腺疾病中，腹腔鏡微創(chuàng)手術(shù)已成為“金標(biāo)準(zhǔn)”術(shù)式[2-3]。在泌尿外科精……