后腹腔镜下经肾周脂肪囊外/内入路肾上腺手术的对比研究

Retroperitoneal laparoscopic adrenalectomy via the extra or intra perinephric fat approach：a comparative study

摘要:

目的 探讨后腹腔镜下经肾周脂肪囊外和经周脂肪囊内途径肾上腺手术的安全性及有效性，为经后腹腔肾上腺肿瘤切除提供经验及依据。方法 收集2017年12月至2023年3月重庆医科大学附属第一医院497例后腹腔镜下肾上腺手术患者的临床资料，回顾性分析２组患者的基本特征及围术期指标的变化。结果 共纳入233例经肾周脂肪囊内途径（intra perinephric fat approach，IPFA）患者，其中腹腔镜手术224例，机器人手术9例，以及264例经肾周脂肪囊外途径（extra perinephric fat approach，EPFA）患者，其中腹腔镜手术253例，机器人手术11例。２组患者的肿瘤大小、估计失血量和手术时间都具有可比性。EPFA组肿瘤大小为（30.47±15.83） mm，与IPFA组相比明显较大（P=0.000）。IPFA组的手术时间长于EPFA组（P=0.000），而IPFA组的估计失血量[（119.07±82.32） mL]低于EPFA组[（158.88±106.94） mL]，差异有统计学意义（P=0.000）。在输血率和住院时间方面，2组之间没有统计学差异。结论 后腹腔镜肾上腺切除术是一种安全有效的手术，可以通过肾周脂肪囊外和肾周脂肪囊内的入路。IPFA在估计失血量及术后输血率比EPFA更少，而EPFA的手术时长则优于IPFA。手术方式的选择可能主要取决于外科医生的经验、肾上腺肿瘤的特征和肾周脂肪的性质。

Abstract:

Objective To investigate the safety and efficacy of retroperitoneal laparoscopic adrenalectomy via the extra or intra perinephric fat approach，and to provide experience and a basis for retroperitoneal adrenalectomy.Methods Related clinical data were collected from 497 patients who underwent retroperitoneal laparoscopic adrenalectomy in The First Affiliated Hospital of Chongqing Medical University from December 2017 to March 2023，and a retrospective analysis was performed for their basic features and the changes in perioperative indicators.Results A total of 233 patients receiving the intra perinephric fat approach（IPFA） were included，among whom 224 underwent laparoscopic surgery and 9 underwent robotic surgery，and 264 patients receiving the extra perinephric fat approach（EPFA） were included，among whom 253 underwent laparoscopic surgery and 11 underwent robotic surgery. The two groups had comparable tumor size，estimated blood loss，and time of operation. The EPFA group had a tumor size of （30.47±15.83） mm，which was significantly larger than the tumor size in the IPFA group（P=0.000）. Compared with the EPFA group，the IPFA group had a significantly longer time of operation（P=0.000） and a significantly lower volume of estimated blood loss[（119.07±82.32） mL vs. （158.88±106.94） mL，P=0.000]. There were no significant differences between the two groups in blood transfusion rate and length of hospital stay.Conclusion Retroperitoneal laparoscopic adrenalectomy is a safe and effective procedure that can be performed via the extra and intra perinephric fat approaches. IPFA patients have lower estimated blood loss and postoperative blood transfusion rate than EPFA patients，while EPFA patients have a longer time of operation than IPFA patients. The selection of surgical approach mainly depends on the experience of the surgeon，the characteristics of adrenal tumor，and the nature of perirenal adipose tissue.