作　　者： (倪栋）; (马鑫）; (李宏召）; (唐露）; (高宇）; (李新涛）; (张旭）;

机构地区： 解放军总医院泌尿外科、解放军总医院肾脏疾病国家重点实验室,北京100853

出　　处： 《临床泌尿外科杂志》 2017年第8期576-579,共4页

摘　　要： 目的:比较经腹腔入路与经腹膜后入路达芬奇机器人辅助腹腔镜肾上腺切除术的疗效,结合典型病例分析不同手术入路的选择依据。方法:2015年5月~2017年5月在我科接受机器人辅助腹腔镜肾上腺肿瘤切除术的患者共49例,回顾性分析其临床基本资料,比较两组患者在性别、年龄、BMI、手术史、肿瘤大小、手术时间、术中失血量、术后是否留置引流管等方面的差异。结果:两组患者在年龄、性别、BMI、肿瘤直径、手术时间、术中出血量、是否留置引流管等方面差异均无统计学意义(P>0.05)。两组患者既往手术史的差异有统计学意义,对于有同侧腹膜后既往手术史的患者均采用经腹腔入路,而存在上腹部手术史的患者80%(4/5)采用了腹膜后入路(P=0.000)。结论:经腹腔与经腹膜后途径机器人辅助腹腔镜肾上腺肿瘤切除术都是安全可行的,二者之间具有相似的手术效果。根据患者既往手术史以及肿瘤的解剖位置特点合理选择手术入路可降低手术难度,达到最佳治疗效果。 Objective：To compare the surgical effect between transperitoneal and retroperitoneal robot-assisted laparoscopic adrenalectomy.And to analyze the surgical approach selection by studying two typical adrenal tumor cases.Method：From May 2015 to May 2017,49 patients with adrenal tumor undergoing robot-assisted laparoscopic adrenalectomy in our department were retrospectively analyzed in this study.Based on the surgical approach,the patients were divided into transperitoneal and retroperitoneal group.The clinical data of the patients were studied including sex,age,BMI,surgical history,tumor size,operation time,blood loss and draining after the surgery.Result：No significant difference was observed between the two groups with regard to sex,age,BMI,tumor size,operation time,blood loss and draining after the surgery（P〉0.05）.And all the patients with an ipsilateral retroperitoneal surgical history were operated by the transperitoneal approach.And 80%（4/5）of the patients with an upper abdominal surgical history were operated by the retroperitoneal approach（P=0.000）.Conclusion：Both transperitoneal and retroperitoneal robot-assisted laparoscopic adrenalectomy were safe and feasible.These two different surgical approaches could achieve equal operative effect.It is recommended to select the surgical approach based on the surgical history of the patients and the anatomy feature of the adrenal tumor.

关 键 词： 肾上腺肿瘤切除术 达芬奇机器人外科手术 手术入路