本文選題：(5～10cm)腎上腺腫瘤 + 后腹腔鏡手術(shù)��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：回顧性分析我院行手術(shù)治療的最大直徑在5～10cm腎上腺腫瘤的患者各項(xiàng)臨床資料與指標(biāo),比較腹膜后腹腔鏡手術(shù)與開(kāi)放手術(shù)在治療直徑5-10cm腎上腺腫瘤的優(yōu)劣勢(shì),并評(píng)價(jià)腹腔鏡手術(shù)(包括腹膜后入路及經(jīng)腹腔入路)在治療大體積腎上腺腫瘤的臨床價(jià)值及安全性、可行性。方法：收集本院2006年1月至2015年1月期間行手術(shù)治療的直徑5～10cm腎上腺腫瘤患者(共88例)的完整臨床資料并進(jìn)行回顧性分析。后腹腔鏡手術(shù)36例(A組),開(kāi)放手術(shù)46例(B組),經(jīng)腹腹腔鏡手術(shù)6例(C組)。統(tǒng)計(jì)其平均手術(shù)時(shí)間、術(shù)中平均估計(jì)出血量、術(shù)中術(shù)后血壓心率波動(dòng)情況、術(shù)中術(shù)后并發(fā)癥情況、術(shù)后平均禁食時(shí)間、術(shù)后引流管引流時(shí)間、術(shù)后應(yīng)用鎮(zhèn)痛情況、術(shù)后平均住院時(shí)間、平均住院總費(fèi)用等臨床資料。同時(shí)在后腹腔鏡手術(shù)組及開(kāi)放手術(shù)組中根據(jù)患者體重指數(shù)(BMI)、病理診斷結(jié)果分為肥胖亞組、嗜鉻細(xì)胞瘤亞組；并對(duì)(A、B)兩組總體及亞組病例的臨床資料進(jìn)行對(duì)比分析。結(jié)果：后腹腔鏡手術(shù)組與開(kāi)放手術(shù)相比結(jié)果如下：后腹腔鏡手術(shù)36例中2例中轉(zhuǎn)改開(kāi)放手術(shù)。后腹腔鏡組在術(shù)中平均估計(jì)出血量、術(shù)中血壓心率波動(dòng)、術(shù)后24h鎮(zhèn)痛率、術(shù)后引流拔除時(shí)間、術(shù)后平均住院天數(shù)及術(shù)中術(shù)后并發(fā)癥方面優(yōu)于開(kāi)放組,并有統(tǒng)計(jì)學(xué)差異(P0.05)。而兩組在平均手術(shù)時(shí)間、術(shù)中輸血例數(shù)、術(shù)后平均禁食時(shí)間、平均住院總費(fèi)用、血壓血鉀改善率等方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。在肥胖患者(BMI30)分組中：后腹腔鏡組在術(shù)中出血量及術(shù)后引流時(shí)間兩方面較開(kāi)放組有優(yōu)勢(shì)(P0.05),而在平均手術(shù)時(shí)間、術(shù)中輸血例數(shù)、術(shù)后切口脂肪液化例數(shù)等方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。在嗜鉻細(xì)胞瘤分組中：后腹腔鏡手術(shù)組在術(shù)中平均估計(jì)出血量及術(shù)中血壓波動(dòng)率方面較開(kāi)放組有優(yōu)勢(shì),并有統(tǒng)計(jì)學(xué)差異(P0.05),而在平均手術(shù)時(shí)間、術(shù)中輸血例數(shù)、術(shù)后轉(zhuǎn)入ICU率及術(shù)后血壓改善率方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。經(jīng)腹腔入路腹腔鏡手術(shù)6例中1例中轉(zhuǎn)開(kāi)放手術(shù),余均獲成功。手術(shù)時(shí)間106～205min,平均155min；術(shù)中估計(jì)出血量100-600ml,平均230ml；輸血2例；術(shù)后禁食時(shí)間2-4d,平均2.6d；術(shù)后引流管拔除時(shí)間4-5d,平均4.8d；術(shù)后住院時(shí)間4-9d,平均6.6d。術(shù)中術(shù)后均無(wú)明顯外科并發(fā)癥。結(jié)論：術(shù)前評(píng)估及圍手術(shù)期準(zhǔn)備充分、腹腔鏡技術(shù)嫻熟、麻醉技術(shù)成熟的前提下腹腔鏡手術(shù)(包括后腹腔入路及經(jīng)腹腔入路)治療直徑5～10cm的腎上腺腫瘤是安全可行的,且與開(kāi)放手術(shù)相比具有創(chuàng)傷小、疼痛少,出血少,術(shù)后并發(fā)癥少、恢復(fù)快等優(yōu)勢(shì)；腫直徑介于5-8cm的腎上腺腫瘤且包膜完整、與周?chē)M織器官邊界清楚、術(shù)者腔鏡技術(shù)嫻熟的可選擇后腹腔入路,直徑8cm的腎上腺腫瘤則選擇經(jīng)腹腔入路可能有更大優(yōu)勢(shì)。
[Abstract]:Objective: To review the clinical data and indexes of the patients with the maximum diameter of 5 ~ 10cm adrenal tumors in our hospital, compare the advantages and disadvantages of retroperitoneal laparoscopic surgery and open surgery in the treatment of 5-10cm adrenal tumors, and evaluate the laparoscopic operation (including retroperitoneal approach and transperitoneal approach) in the general treatment of the adrenal tumor. The clinical value and safety of adrenal tumor and its feasibility. Methods: the complete clinical data of 5 ~ 10cm adrenal tumors (88 cases) in diameter from January 2006 to January 2015 were collected and analyzed retrospectively. 36 cases (group A), 46 cases of open surgery (group B), and 6 cases of abdominal laparoscopy (C The average operation time, intraoperative mean estimated bleeding, postoperative blood pressure and heart rate fluctuation, postoperative complications, postoperative average fasting time, postoperative drainage tube drainage time, postoperative analgesia, average hospitalization time after operation, average total hospitalization expenses and other clinical data. In the open operation group, according to the patient's body mass index (BMI), the pathological diagnosis was divided into obesity subgroup and pheochromocytoma subgroup, and the clinical data of two groups and subgroups of (A, B) were compared and analyzed. Results: the results of the retroperitoneal laparoscopic operation group and the open operation were compared with the open operation in 36 cases, 2 cases were converted to open surgery. The average amount of bleeding, the fluctuation of blood pressure and heart rate, the postoperative 24h analgesic rate, the postoperative drainage time, the average days of hospitalization and the postoperative complications were better than those in the open group (P0.05). The two groups were in the average operation time, the average time of postoperative fasting, and the average time. There was no significant difference in total hospital cost, blood pressure and blood potassium improvement rate (P0.05). In the group of obese patients (BMI30), there were two advantages (P0.05) in the amount of intraoperative bleeding and the postoperative drainage time in the post laparoscopic group (P0.05), but there was no significant difference in the average operation time, the number of intraoperative blood transfusions, and the number of postoperative incision fat liquefaction (P0 .05). In the pheochromocytoma grouping: the average estimated bleeding volume and the intraoperative blood pressure fluctuation in the postlaparoscopic operation group were superior to those in the open group, and there were statistical differences (P0.05). There was no statistical difference between the average operation time, the number of intraoperative blood transfusions, the rate of ICU and the improvement of blood pressure after operation (P0.05). Of the 6 cases of laparoscopic surgery, 1 cases were transferred to the open operation. The operation time was 106 ~ 205min, average 155min, the amount of bleeding was 100-600ml, the average 230ml, the blood transfusion was 2 cases, the time of the postoperative fasting was 2-4d, the average 2.6d; the drainage time was 4-5d, the average 4.8d, the postoperative hospital time was 4-9d, and the mean 6.6d. operation was not clear. Surgical complications. Conclusions: preoperative assessment and perioperative period preparation, laparoscopic technique and mature anesthesia, laparoscopic surgery (including retroperitoneal approach and transperitoneal approach) are safe and feasible for the treatment of adrenal tumors with a diameter of 5 to 10cm, and are less traumatic, less painful, less bleeding, and less bleeding than open surgery. There are fewer complications and faster recovery. The adrenal tumors with a diameter of 5-8cm are adrenal tumors with a complete envelope, clear boundaries with the surrounding tissues and organs, and the surgeons have a skilled and skilled posterior intraperitoneal approach. The diameter of the adrenal tumor with a diameter of 8cm may have a greater advantage.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R736.6

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