摘要目的 探讨侧卧位后腹腔入路(A组)、侧卧位前路经腹入路(B组)和70°斜侧卧位肋弓下缘经腹入路(C组),3种入路腹腔镜肾上腺手术的临床疗效比较.方法 3种入路共实施肾上腺手术219例,比较3组患者肿瘤直径、手术时间、术中出血量、术后肠功能恢复时间、住院天数、术后并发症发生及操作舒适性评分等指标.结果 A组和B组各3例,C组1例中转开放手术;术中平均失血量:A组57.5 ml,B组42.7 ml,C组35.2 ml,A组显著多于B组和C组,B组和C组差异无统计学意义(P＞0.05);操作舒适性评分:A组6.3分,B组5.9分,C组7.4分.切除肿瘤的平均直径、平均手术时间、术后肠功能恢复时间、术后平均住院时间,3组间差异无统计意义(P＞0.05).结论 3种手术入路均可有效治疗肾上腺腺瘤,建议根据熟练程度、肿瘤大小、患者体型合理选择手术入路.

abstractsObjective To explore the clinical value of three approaches laparoscopic adrenalectomy,including:the lateral position retroperitoneal approach (group A),the lateral position anterior abdominal approach (group B) and 70 ° recumbency position under costal arch transabdominal approach (group C).Methods The total of 219 patients who underwent laparoscopic adrenal surgery by the three approaches were involved.The three groups were compared with tumor size,operative time,blood loss,postoperative intestinal function recovery time,hospital stay,postoperative complications and operating comfort score indicators.Results Of the 219 cases,212 were successful and 7 required conversion to open surgery.There were no statistically significant differences among the three groups in terms of mean tumor size,mean operative time,postoperative intestinal function recovery time and the average hospital stay,however,average volumes of blood loss was 57.5 ml in group A,which more than that in group B 42.7 ml and group C 35.2 ml.The reference visual analogue scale mode operating comfort rating:A group is 6.3,B group is 5.9,C group is 7.4.Conclusion Three surgical approach can be effective in treating adrenal adenoma,A reasonable choice of surgical approach recommended based on proficiency,tumor size and patient body type.