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首页> 外文期刊>Surgical Endoscopy >Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift.
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Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift.

机译：后腹膜后肾上腺切除术在三级护理中心的影响：范式转变。

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BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has substituted its anterior laparoscopic counterpart as the treatment of choice in the management of adrenal tumors at the authors' institution. The authors present their comparative results between these operative techniques, demonstrating the reasons for this change. METHODS: From May 2008 to September 2010, 30 patients underwent posterior retroperitoneoscopic adrenalectomy. Operative time, complications, hospital stay, postoperative pain, and cost were compared with those of 30 selected laparoscopic control subjects treated from 2005 to 2010. Statistical analysis was based on Chi-square, the Mann-Whitney U test, the independent-samples t-test, and the Wilcoxon matched pairs test, as appropriate. RESULTS: The median tumor size was 3.8 cm (range, 1.5-8.0 cm) in the retroperitoneoscopic group and 4.9 cm (range, 2.4-8.0 cm) in the laparoscopic group. The median operative time was similar between the two groups (90.0 min; range, 60-165 min vs. 77.5 min; range, 55-120 min; P = 0.138). It was, however, significantly reduced after the 20th case (97.5 min; range, 80-165 min vs. 70 min; range, 60-110 min; P < 0.001) in the retroperitoneoscopic group. The median visual analog pain scores were significantly lower in the retroperitoneoscopic group on both the first and the third postoperative days, respectively (1; range, 0-1 vs. 4; range, 3-6; P < 0.001 and 0; range, 0-1 vs. 3; range, 2-6; P < 0.001). The median postoperative hospital stay also was shorter in the retroperitoneoscopic group (2 days; range, 2-3 days vs. 4 days; range, 3-6 days; P < 0.001). The cost of the posterior approach was significantly less than that of the laparoscopic technique (P < 0.001). CONCLUSIONS: Posterior retroperitoneoscopic adrenalectomy compared with laparoscopic adrenalectomy was safe, fast, and vastly superior in terms of postoperative pain and hospital stay in this series. Because of the ability to reproduce such excellent operative results, the impressive patient recovery, and the significantly reduced operative cost, the authors suggest that the retroperitoneoscopic approach should become the method of choice in minimally invasive adrenal surgery.
机译：背景：腹腔镜后肾上腺切除术已取代其腹腔镜前对应术作为作者所在机构治疗肾上腺肿瘤的首选治疗方法。作者介绍了这些手术技术之间的比较结果，说明了这种变化的原因。方法：2008年5月至2010年9月，对30例患者进行了腹膜后腔镜肾上腺切除术。将手术时间，并发症，住院时间，术后疼痛和费用与2005年至2010年选择的30例腹腔镜对照组进行比较。统计学分析基于卡方检验，Mann-Whitney U检验，独立样本t -test和Wilcoxon配对配对测试（视情况而定）。结果：腹腔镜后组中位肿瘤大小为3.8 cm（范围1.5-8.0 cm），腹腔镜组中位肿瘤大小为4.9 cm（范围2.4-8.0 cm）。两组的中位手术时间相似（90.0分钟;范围60-165分钟与77.5分钟;范围55-120分钟; P = 0.138）。然而，在腹腔镜后组中，在第20例病例后，其明显减少（97.5分钟;范围80-165分钟vs. 70分钟;范围60-110分钟; P <0.001）。腹腔镜后组在术后第一天和第三天的视觉模拟疼痛中位数分别显着降低（1;范围：0-1比4;范围：3-6; P <0.001和0;范围： 0-1比3;范围2-6; P <0.001）。腹腔镜后组的中位术后住院时间也较短（2天; 2-3天vs. 4天; 3-6天; P <0.001）。后路手术的费用明显低于腹腔镜手术的费用（P <0.001）。结论：本系列腹腔镜后肾上腺切除术与腹腔镜下肾上腺切除术相比，安全，快速，并且在术后疼痛和住院时间方面均优越得多。由于能够再现如此出色的手术效果，令人印象深刻的患者康复以及显着降低的手术成本，作者建议腹腔镜后方法应成为微创肾上腺手术的首选方法。

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