Comparison of the perioperative period between the Da Vinci robot and conventional laparoscopy with different approaches in adrenal pheochromocytoma resection
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摘要: 目的:探讨3种手术方式在肾上腺嗜铬细胞瘤切除术中的临床应用价值,提高肾上腺嗜铬细胞瘤的治疗水平。方法:回顾性分析2009年1月—2019年12月在我院手术治疗的186例嗜铬细胞瘤患者的临床资料,比较经腹腔、经后腹腔和机器人辅助腹腔镜手术在围术期的各项数据。结果:经后腹腔组在手术时间、术后恢复进食及术后引流液量方面均优于经腹腔组;而在术中血压波动、中转开放率、失血量及术后拔除引流管时间方面,二者无明显差异;经腹机器人手术组在手术时间和切除巨大肿瘤方面优于经腹腔组。结论:经后腹腔行腹腔镜肾上腺嗜铬细胞瘤切除术的手术时间短、患者恢复快,可作为肿瘤体积较小(＜5 cm)患者优先选择的手术方式;机器人手术因精细度高,操作灵活更适合肿瘤体积较大的复杂性嗜铬细胞瘤患者。Abstract: Objective: To evaluate the clinical significance of three surgical techniques in the removal of adrenal pheochromocytoma and to improve the outcome of treatment.Methods: We retrospectively reviewed and analyzed the medical records of 186 patients with pheochromocytoma who underwent surgery from January 2009 to December 2019, and the perioperative data of peritoneal, retroperitoneal and robot-assisted laparoscopic surgery were compared.Results: Compared with transperitoneal group, the operating time, time of postoperative feeding and drainage volume were less in retroperitoneal group. There was no significant difference in intraoperative blood pressure fluctuation, conversion rate, blood loss or postoperative drainage tube removal time between the transperitoneal group and the retroperitoneal group. Robot assisted laparoscopic resection of adrenal pheochromocytoma is superior to transperitoneal laparoscopic surgery in terms of the operating time and removal of large tumors.Conclusion: Retroperitoneal approach in laparoscopic adrenal pheochromocytoma resection has advantages of shorter operation time and faster recovery, which can be used as a preferred surgical method for patients with small tumor size(＜5 cm). Robot assisted laparoscopic resection of adrenal pheochromocytoma is more suitable for complicated patients with large tumor due to its high degree of refinement.
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