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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 efficacy of transabdominal and retroperitoneal labyrinth-assisted laparoscopic assisted laparoscopic adrenalectomy, and to analyze the choice of different surgical approaches with typical cases. METHODS: From May 2015 to May 2017, 49 patients undergoing robot-assisted laparoscopic adrenalectomy in our department were retrospectively analyzed. Basic data were compared between the two groups in terms of gender, age, BMI, surgical history , Tumor size, operation time, intraoperative blood loss, postoperative indwelling drainage tube and other differences. Results: There was no significant difference between the two groups in terms of age, sex, BMI, tumor diameter, operation time, intraoperative blood loss, drainage catheter placement, etc. (P> 0.05). Two groups of patients with previous surgical history of the difference was statistically significant, for patients with ipsilateral retroperitoneal history of surgery were used by transperitoneal approach, while there is a history of upper abdominal surgery in 80% (4/5) of the retroperitoneal Approach (P = 0.000). Conclusions: Laparoscopic and retroperitoneal robotic assisted laparoscopic adrenalectomy is safe and feasible, with similar surgical results. According to the history of patients with previous surgery and tumor anatomical characteristics of the location of a reasonable choice of surgical approach can reduce the difficulty of surgery to achieve the best therapeutic effect.