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目的:分析侧卧位前路经腹入路与70°斜侧卧位肋弓下缘经腹入路腹腔镜肾上腺手术的临床治疗效果。方法:选择2014年7月至2016年6月行经腹入路腹腔镜肾上腺手术160例患者,随机分为观察组与对照组,每组各80例。对照组患者采用侧卧位前路经腹入路,观察组患者采用70°斜侧卧位肋弓下缘经腹入路,观察两组患者的术中出血量、手术时间、下床活动时间、术后肠功能恢复时间、住院时间以及术后并发症发生率。结果:观察组患者的术中出血量以及手术时间低于对照组(P<0.05),两组患者的下床活动时间、术后肠功能恢复时间以及住院时间相比差异无统计学(P>0.05);两组患者均未出现大血管和重要脏器损伤,对照组患者出现2例腹壁血肿,观察组患者出现1例通道周边皮下气肿,2例术后腹胀;观察组患者的并发症发生率为3.75%(3/80),与对照组的2.50%(2/80)相比差异无统计学意义(P>0.05)。结论:与经腹侧卧位前入路相比,70°斜侧卧位肋弓下缘经腹入路手术视野大,暴露清楚,术中出血量少,手术时间短,值得应用推广。
Objective: To analyze the clinical effect of transabdominal laparoscopic adrenalectomy via the transabdominal approach of the anterior lateral approach and the lower edge of the Costa Rica rib along the 70 ° oblique lateral position. Methods: From July 2014 to June 2016, 160 patients undergoing laparoscopic adrenalectomy via abdominal approach were randomly divided into observation group and control group, 80 cases in each group. Patients in the control group received transabdominal approach in the anterior lateral decubitus. The patients in the observation group underwent abdominal transtibial approach through the lower edge of the rib arch in the 70 ° oblique lateral position to observe the intraoperative blood loss, operation time, , Postoperative bowel function recovery time, hospitalization time and the incidence of postoperative complications. Results: The intraoperative blood loss and operation time in the observation group were lower than those in the control group (P <0.05). There was no significant difference in ambulation time, postoperative intestinal function recovery time and hospital stay between the two groups (P> 0.05). Two groups of patients had no major vessel and major organ injury, 2 cases of abdominal hematoma in the control group, 1 case of subcutaneous emphysema in the observation group and 2 cases of postoperative abdominal distension. The complication of the observation group The incidence was 3.75% (3/80), which was no significant difference compared with 2.50% (2/80) in the control group (P> 0.05). CONCLUSION: Compared with transabdominal prevertebral approach, the surgical approach to the lower edge of rib arch in the 70 ° oblique lateral position is large, with a clear exposure, less blood loss and shorter operation time. It is worthy of promotion.