CAJ | 학술논문

目的：比较后腹腔镜与传统开放手术治疗肾上腺肿瘤的优缺点。方法将2005年1月至2010年12月接受治疗的120例肾上腺肿瘤患者，通过计算机产生随机数学表，按1∶1分配原则随机分为后腹腔镜组与开放手术组，比较2组的手术相关指标、术后恢复指标、术后处理情况、手术成功情况、并发症和随访情况。结果后腹腔镜组1例因拒绝接受腹腔镜手术，2例缺乏随访资料而脱落；开放手术组因2例转院，2例缺乏随访资料而脱落。后腹腔镜组（57例）和开放手术组（56例）的手术时间、术中出血量、输血例数分别为（89.6±18.4）min、（70.2±17.2）ml、8例和（124.2±27.3）min、（205.7±51.9）ml、20例；拔管时间、进食时间、下床时间、住院时间分别为（2.8±1.3） d、（1.7±1.1） d、（2.6±1.2） d、（6.2±3.1） d和（4.2±2.0）d、（2.9±1.4）d、（5.1±3.1）d、（13.5±5.4）d；术后镇痛例数、引流量分别为11例、（15.4±4.2）ml和43例、（45.1±12.7）ml；以上指标比较差异均具有统计学意义（P＜0.01），2组的治疗费用比较差异无统计学意义（ P＞0.05）。开放手术组1年内无一例死亡和复发，后腹腔镜组有5例中转开腹，1年内1例死亡、2例复发。后腹腔镜组和开放手术组分别有2例（3.51％）和9例（16.07％）出现并发症，差异具有统计学意义（ P＜0.01）。结论与传统开放手术相比，后腹腔镜治疗肾上腺肿瘤，具有创伤小、并发症少和术后恢复快等优点，但仍存在手术失败和复发的可能，需要进一步提高泌尿外科医生的经验和操作技巧。
목적：비교후복강경여전통개방수술치료신상선종류적우결점。방법장2005년1월지2010년12월접수치료적120례신상선종류환자，통과계산궤산생수궤수학표，안1∶1분배원칙수궤분위후복강경조여개방수술조，비교2조적수술상관지표、술후회복지표、술후처리정황、수술성공정황、병발증화수방정황。결과후복강경조1례인거절접수복강경수술，2례결핍수방자료이탈락；개방수술조인2례전원，2례결핍수방자료이탈락。후복강경조（57례）화개방수술조（56례）적수술시간、술중출혈량、수혈례수분별위（89.6±18.4）min、（70.2±17.2）ml、8례화（124.2±27.3）min、（205.7±51.9）ml、20례；발관시간、진식시간、하상시간、주원시간분별위（2.8±1.3） d、（1.7±1.1） d、（2.6±1.2） d、（6.2±3.1） d화（4.2±2.0）d、（2.9±1.4）d、（5.1±3.1）d、（13.5±5.4）d；술후진통례수、인류량분별위11례、（15.4±4.2）ml화43례、（45.1±12.7）ml；이상지표비교차이균구유통계학의의（P＜0.01），2조적치료비용비교차이무통계학의의（ P＞0.05）。개방수술조1년내무일례사망화복발，후복강경조유5례중전개복，1년내1례사망、2례복발。후복강경조화개방수술조분별유2례（3.51％）화9례（16.07％）출현병발증，차이구유통계학의의（ P＜0.01）。결론여전통개방수술상비，후복강경치료신상선종류，구유창상소、병발증소화술후회복쾌등우점，단잉존재수술실패화복발적가능，수요진일보제고비뇨외과의생적경험화조작기교。
Objective To compare the advantages and disadvantages of retroperitoneal laparoscopic sur -gery and open surgery in treatment of adrenal adenoma , in order to provide the clinical evidence for the selection of surgical treatment of adrenal adenoma .Methods 120 cases undergoing surgical treatment from Jan .2005 to Dec.2010 were randomly divided into laparoscopic group and open surgery group .Operation indicators , postop-erative recovery indicators , postoperative clinical manifestations , success of operation , complications and follow-up data were evaluated and compared between the 2 groups.Results 3 cases in laparoscopic group and 4 cases in open surgery group withdrew.The operation time, intraoperative blood loss, and blood transfusion cases were (89.6 ±18.4)min vs (124.2 ±27.3)min, (70.2 ±17.2)ml vs (205.7 ±51.9)ml, and 8 cases vs 20 cases in laparo-scopic group and open surgery group .Extubation time, starting feeding time, time of getting out of bed, and length of hospital stay were (2.8 ±1.3)d vs (4.2 ±2.0)d, (1.7 ±1.1)d vs (2.9 ±1.4)d, (2.6 ±1.2)d vs (5.1 ± 3.1)d and (6.2 ±3.1)d vs (13.5 ±5.4)d in laparoscopic group and open surgery group .Postoperative analge-sic using cases and drainage volume were 11 cases vs 43 cases, and(15.4 ±4.2)ml vs(45.1 ±12.7)ml in lapa-roscopic group and open surgery group .The difference had statistical significance (P<0.01).The cost was simi-lar between the 2 groups(P>0.05).The open surgery group had no death or relapse within 1 year, while 5 cases in laparoscopic group converted to laparotomy , with 1 case of death and 2 cases of relapse within 1 year.The complications incidence was 3.51%(2/57)in laparoscopic group, obviously lower than 16.07%(9/56)in open surgery group(P<0.01).Conclusions Compared to the traditional open surgery, retroperitoneal laparoscopic sur-gery has advantages of less trauma, fewer complications, and faster postoperative recovery in treatment of adrenal ade-noma.Experience and skills of surgeon need to be improved to reduce the possibility of failure or recurrence .