摘要
目的 比较不同入路腹腔镜肾上腺肿瘤切除术在功能性肾上腺肿瘤治疗中的应用效果.方法 选择2012年9月至2022年9月濮阳市安阳地区医院收治的60例功能性肾上腺肿瘤患者为研究对象.根据腹腔镜入路方式将患者分为后腹腔入路组(n=31)和腹腔入路组(n=29).比较2组患者手术相关指标、应激指标、免疫学指标及术后并发症发生情况.结果 后腹腔入路组患者术中出血量、治疗费用显著低于腹腔入路组,手术时间、术后首次进食时间、住院时间显著短于腹腔入路组(P＜0.05).术前、术后,2组患者血清皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)水平比较差异均无统计学意义(P＞0.05);2组患者术后血清Cor、NE、E水平显著高于术前(P＜0.05).术前2组患者CD4+、CD8+、CD4+/CD8+水平比较差异无统计学意义(P＞0.05);2组患者术后CD4+、CD4+/CD8+水平显著低于术前,CD8+水平显著高于术前(P＜0.05);腹腔入路组患者术后CD4+、CD4+/CD8+水平显著低于后腹腔入路组(P＜0.05),2组患者术后CD8+水平比较差异无统计学意义(P＞0.05).后腹腔入路组、腹腔入路组患者术后并发症发生率分别为6.45％(2/31)、31.03％(9/29),后腹腔入路组患者术后并发症发生率显著低于腹腔入路组(x2=6.048,P＜0.05).结论 腹腔入路与后腹腔入路腹腔镜肾上腺肿瘤切除术治疗功能性肾上腺肿瘤的疗效确切,2种入路方式产生的应激反应程度相当,但后腹腔入路的手术时间更短、术中出血量少、术后恢复更快、对免疫功能的损伤更小、术后并发症发生率更低,且更具有经济性.
Abstract
Objective To compare the effects of different approaches of laparoscopic adrenal tumor resection in treating functional adrenal tumors.Methods Sixty patients with functional adrenal tumors admitted to the Anyang District Hospital from September 2012 to September 2022 were selected as the research subjects.According to different laparoscopic approaches,the patients were divided into a retroperitoneal laparoscopic adrenalectomy group(n=31)and an intraperitoneal laparoscopic adrenalectomy group(n=29).The operation related indexes,stress indexes,immunological indexes,and postoperative complications were compared between the two groups.Results The amount of bleeding and treatment cost in the retroperitoneal laparoscopic adrenalectomy group were lower than those in the intraperitoneal laparoscopic adrenalectomy group,and the operation time,the first meal time after operation,and the hospital stay were shorter than those in the intraperitoneal laparoscopic adrenalectomy group(P＜0.05).There was no statistically significant difference in serum cortisol(Cor),noradrenaline(NE)and adrenaline(E)levels between the two groups before and after operation(P＞0.05).After operation,the levels of serum Cor,NE and E in the two groups were significantly higher than those before operation(P＜0.05).Before operation,there was no statistically significant difference in CD4+level,CD8+level,and CD4+/CD8+ratio between the two groups(P＞0.05).After operation,the CD4+level and CD4+/CD8+ratio in both groups were significantly lower than those before operation,while the CD8+level was significantly higher than that before operation(P＜0.05).After operation,the CD4+level and CD4+/CD8+ratio in the intraperitoneal laparoscopic adrenalectomy group were significantly lower than those in the retroperitoneal laparoscopic adrenalectomy group(P＜0.05);there was no statistically significant difference in the CD8+level between the two groups(P＞0.05).The incidence of postoperative complications in the retroperitoneal laparoscopic adrenalectomy group and the intraperitoneal laparoscopic adrenalectomy group was 6.45％(2/31)and 31.03％(9/29),respectively;it was significantly lower in the retroperitoneal laparoscopic adrenalectomy group(x2=6.048,P＜0.05).Conclusion Laparoscopic adrenalectomy via intraperitoneal approach and retroperitoneal approach is effective in the treatment of functional adrenal tumors.The degree of stress response generated by the two approaches is similar,but the retroperitoneal approach has shorter operation time,less intraoperative bleeding,faster postoperative recovery,less damage to immune function,lower incidence of postoperative complications,and fewer costs.
维普
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