| Background and objectives:Laparoscopic adrenalectomy is a surgical treatment of unilateral adrenal benign tumor.Compared with traditional open surgery,laparoscopic adrenalectomy has the advantages of smaller incision,less bleeding,better visual field and shorter operative time.According to different approaches,laparoscopic adrenalectomy can be mainly divided into transperitoneal laparoscopic adrenalectomy（TLA）and retroperitoneal laparoscopic adrenalectomy（RLA）.The two methods have their own advantages and disadvantages:TLA has a clear field of vision,which is beneficial to the operative,but the risk of injury to abdominal organs is higher,which may affect the recovery of gastrointestinal tract.RLA reduces the irritation of abdominal organs,but due to the small field of vision,narrow operating space,unclear anatomical signs,it has the risk of penetrating the peritoneum,and it requires the operator has higher operative techniques for the surgeons.Adrenalectomy can be divided into total adrenalectomy（TA）and partial adrenalectomy（PA）.Laparoscopic total adrenalectomy is the first choice for adrenal tumor surgery.With the development of laparoscopic technology,PA has been chosen by more and more surgeons in order to avoid the symptoms of postoperative corticosteroid deficiency and adrenal crisis caused by total adrenalectomy..The purpose of this paper is to collect the data of patients with benign adrenal tumors,to compare the effects of different laparoscopic adrenalectomy on the operation and postoperative recovery of patients,and to explore the choice of surgical methods and perioperative treatment in the treatment of adrenal tumors.Methods:The clinical data of benign adrenal neoplasm patients who were hospitalized and undergoing laparoscopic surgery in the Department of Urology of the affiliated Provincial Hospital of Shandong University from January 2018 to January 2020 were collected in this study.The inclusion criteria were patients who underwent laparoscopic adrenalectomy with adrenocortical adenoma or PHEO.The exclusion criteria were patients with bilateral adrenal lesions,severe incompleteness of clinical data,and underwent surgery besides adrenal gland at the same time.Compare the differences of clinical indexes such as operative time,incidence of postoperative complications,drainage volume on the first day,exsufflation time and postoperative extubating time between TLA group and RLA group,TA group and PA group.The patients were divided into different subgroups according to tumor side,tumor size and pathology,and the differences of TLA and RLA in each subgroup were compared.The factors affecting the duration of operation and postoperative corticosteroid deficiency were analyzed.IBM SPSS statistics 26.0 is used for statistical analysis.The measurement data with normal distribution were expressed by mean ±standard deviation.The samples with the normal distribution were compared with the independent sample t-test.The statistical analysis of disordered classified variables was conducted by Pearson χ2 test or continuity correction χ2 test.The influencing factors were analyzed by binary logistic regression.The difference（p<0.05）was statistically significant.Results:175 patients were included in this study through the inclusion and exclusion criteria.In 175 patients,there were 148 cases of adrenocortical adenomas（42 patients were APA,4 patients were CPA）.And there were 27 cases of PHEO.All the 175 patients were operated successfully.There were 73 cases in TLA group and 102 cases in RLA group.In TLA group,there were 34 cases in TA and 39 cases in PA.In RLA group,there were 39 cases in TA and 63 cases in PA.1.For TLA group and RLA group,maximum diameter of tumor size were 3.53±2.29cm vs.2.39±1.41cm,p<0.01,operative time were 146.99±58.11min vs.114.46±34.83min,p<0.01,drainage volume on the first day operatively were 83.08±58.39ml vs.61.91±35.63cm,p<0.01,postoperative extubating time were 3.19±1.99d vs.2.45±0.77d,p<0.01 and anal exsufflation time were 2.63±0.69d vs.2.40±0.59d,p<0.05.It had no difference of clinical symptom occurrence rate postoperatively due to being lack of corticosteroids.（p>0.05）Considering the difference of anatomy between the left and right abdominal cavity,a comparison was made in the two subgroups of tumors on the left and right sides.1.1 In the left subgroup,the operation time of TLA group and RLA group were 152.81±65.46min vs.114.44±33.23min,p<0.01,drainage volume on the first day postoperatively were 90.63±65.61ml vs,65.89±39.02 ml,p<0.05,and postoperative extubating time were 3.35±2.13d vs.2.55±0.82d respectively,p<0.01.1.2 In the right subgroup,the operation time of TLA group and RLA group were 136.20±39.00min vs.113.25±35.97min,p<0.05.There was no significant difference in other clinical indexes.2.For TA group and PA group,there had significant difference in clinical symptoms occurrence rate of postoperative due to being lack of corticosteroids（15.1%vs.5.9%,p<0.05）.It had no difference in drainage volume on the first day postoperatively,anal exsufflation time,postoperative extubation time.（p>0.05）3.Different pathological groups3.1 For maximum tumor diameter<4cm subgroup（85 cases）of nonfunctional adrenal adenomas,It had no difference in anal exsufflation time,drainage volume on the first day postoperatively,postoperative extubation time and operative time among different surgical approaches.（p>0.05）.3.2 For maximum tumor diameter ≥6cm subgroup（13 cases）of PHEO,there were no significant difference in tumor size,anal exsufflation time,drainage volume on the first day postoperatively,postoperative extubation time and operative time between TLA group and RLA group（p>0.05）4.Among nonfunctional adrenal adenomas group,gender,mode of operation,level of preoperative corticosteroids and the maximum diameter of the tumor were included as independent variables,and the symptoms of corticosteroid deficiency after operation as dependent variables,and logistic regression analysis was performed.Among them,the mode of operation was an independent factor affecting the occurrence of corticosteroid deficiency symptoms（p<0.05）.The incidence of corticosteroid deficiency in PA group was 0.226 times higher than that in TA group.5.The median of operative time was 120 minutes,including gender,mode of operation,surgical approach,tumor side,pathology and maximum diameter of tumor as independent variables,and operation duration ≥120min as dependent variable.Multivariate logistic regression analysis showed that tumor side,gender and pathological PHEO were independent factors affecting the duration of operation≥120min（p<0.05）.The risk of occurrence in the female group was 0.449 times higher than that in male.The risk in the right tumor group was 0.478 times higher than that in the left group.The risk in PHEO patients was 6.169 times higher than that of non-PHEO patients.Conclusion:1.Overall,operative time in RLA was shorter than that in TLA group.In the left subgroup,the drainage volume and postoperative extubating time in RLA group were significantly lower than those in TLA group,but there was no statistical difference in the right subgroup.2.For non-functioning adrenocortical adenomas which is less than 4cm diameter,there was no significant difference in anal exsufflation time,drainage time on the first day postoperatively,postoperative extubation time and operative time among different surgical approaches.3.For PHEO patients with tumor which is larger than 6cm diameter,there was no significant difference in tumor size,anal exsufflation time,drainage time on the first day postoperatively,postoperative extubation time and operative time among different surgical approaches.When choosing a surgical approach,the experience of the operator and other factors should also be taken into account.4.Gender,tumor side and PHEO were the independent factors affecting the duration of operative time ≥120min.5.Corticosteroid deficiency occurs more likely after the surgery of laparoscopic total adrenalectomy.In the non-functional adenoma group,the mode of operation is an independent factor affecting the occurrence of corticosteroid deficiency symptoms. |
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