Comparison Of Therapeutic Effects And Analysis Of Complications Of Laparoscopic Adrenal Surgery With Two Approaches

Objective:Laparoscopic Adrenalectomy(LA)has been widely used in clinical practice.The main methods are Transperitoneal Laparoscopic Adrenalectomy(TLA)and Retroperitoneal Laparoscopic Adrenalectomy(RLA).Through the analysis of the complete clinical data of laparoscopic adrenal surgery in our department,the intraoperative and postoperative indexes of the two surgical approaches were compared,and the risk factors of postoperative complications were analyzed to guide the selection of appropriate surgical approach before operation.Materials and Methods:The article collected clinical data of 99 patients who underwent laparoscopic adrenalectomy in our department from January 2019 to December 2020,including 22 patients who underwent TLA and 77 patients who underwent RLA.With the help of statistical methods,the included data were compared and analyzed,including the size of lesions,the length of operation,the amount of intraoperative blood loss,the additional use of analgesics after operation and the days of hospitalization after operation.We analyze the advantages and disadvantages of transabdominal adrenal surgery and retroperitoneal adrenal surgery synthetically.At the same time,we divide the variable conditions into groups according to age,body mass index,basic diseases and tumor size,compare the differences between the two approaches.Results:A total of 99 patients in the TLA and RLA groups were successfully performed without transit open surgery.The overall comparison of TLA and RLA results: In TLA group,the length of operation was(62.7±10.3)minutes,the amount of intraoperative blood loss was(40.9±9.2)ml,the postoperative ventilation time was(27.2±9.4)hours,and the postoperative hospital stay was(12.5±3.8)days.In RLA group,the operative length was(81.3 ±13.4)minutes,the intraoperative blood loss was(47.1±11.2)ml,the postoperative ventilation time was(30.6±10.5)hours,and the postoperative hospital stay was(8.5±3.5)days.There were significant differences in operation time,intraoperative blood loss and postoperative hospital stay between the two groups(P<0.05),but there was no significant difference in postoperative ventilation time(P>0.05).The group of tumor large than 6cm:In TLA group,the operation time was(58.6±14.6)min,the intraoperative blood loss was(44.3±5.3)ml,the postoperative ventilation time was(23.4±7.7)h,and the postoperative hospital stay was(15.3±3.0)d.In RLA group,the operation time was(65.6 ±5.3)minutes,the intraoperative blood loss was(48.9±6.0)ml,the postoperative ventilation time was(34.1±10.8)hours,and the postoperative hospital stay was(13.2 ±7.0)days.There was no significant difference in operation time,intraoperative blood loss and postoperative hospital stay(P>0.05),but there was significant difference in postoperative ventilation time(P<0.05).The group of pheochromocytoma :In TLA group,the operation time was(56.0±5.5)min,the intraoperative blood loss was(42.0±4.5)ml,the postoperative ventilation time was(28.6±3.2)h,and the postoperative hospital stay was(9.0±3.5)d.In RLA group,the operation time was(75.0±17.3)minutes,the intraoperative blood loss was(45.0±12.9)ml,the postoperative ventilation time was(37.8±10.4)hours,and the postoperative hospital stay was(16.4±1.7)days.There was no significant difference in operation time,intraoperative blood loss andpostoperative ventilation time(P>0.05),but there was significant difference in postoperative hospital stay(P<0.05).The comparison of the two surgical methods in the tumor < 6cm group and the non-pheochromocytoma group was consistent with the overall situation.There was no significant difference in the influence of pathological changes on operation in TLA group(P>0.05).Univariate and multivariate Logistic regression analysis showed that tumors large than 6cm was an independent risk factor for postoperative complications(Univariate logistic regression analysis: OR=15.36,95%CI:3.76-62.84,P< 0.001;Multivariate logistic regression analysis: OR=6.41,95% CI:1.91-21.57,P=0.003).Conclusion:(1)Both RLA and TLA can achieve the therapeutic effect of adrenal tumor.TLA has shorter operation time and less intraoperative bleeding.RLA has faster postoperative recovery and shorter postoperative hospital stay than TLA.(2)For the tumors large than 6cm,regardless of whether they are pheochromocytomas or not,the therapeutic effects of the two approaches are similar.But for those tumors less than6 cm,it is recommended to choose RLA to recover quickly.While,TLA may be the better choice for pheochromocytoma.(3)The occurrence of postoperative complications is mainly related to the size of the tumor.The diameter of tumor large than 6cm is an independent risk factor for postoperative complications.Full preparation is required before operation.