Clinical Efficacy Analysis Of Adrenal Central Vein Approach And Management In Retroperitoneal Laparoscopic Adrenalectomy

BackgroundThe adrenal gland is an important gland and plays an important role.The presence of lesions can lead to clinical symptoms of excessive secretion of related hormones.Adrenal tumors are common,and their lesions include primary aldosteronism(aldosteronoma),pheochromocytoma,Cushing's syndrome,etc.,and also include malignant tumors such as adrenal sebaceous gland cancer,metastases,and the like.Laparoscopic adrenalectomy has been proposed by Gagner et al in 1992.Currently,laparoscopic adrenalectomy has become the first choice for surgical treatment of benign adrenal tumors.Minimally invasive laparoscopic adrenalectomy mainly involves two minimally invasive surgical approaches,transabdominal approach and retroperitoneal approach.Retroperitoneal laparoscopic adrenalectomy is the main surgical procedure in China.The anatomical retroperitoneal laparoscopic adrenalectomy proposed by Professor Zhang Xu is widely recognized.The adrenal gland is deep,the blood vessels are rich,and the approach is complicated.Intraoperative treatment of the adrenal central vein and adjacent renal arteriovenous and inferior vena cava injury is common.Various complications often occur in retroperitoneal laparoscopic adrenalectomy,of which the major complication is major bleeding.The safe release and ligation of the central adrenal vein during surgery is the focus and difficulty,but there are few reports on the free treatment of the central adrenal vein.Analysis of the central adrenal venous approach and treatment has important clinical value,which can provide reference for future minimally invasive adrenalectomy.ObjectThrough the analysis of intraoperative important vascular adrenal central venous approach and treatment,and other clinical data from laparoscopic adrenalectomy in the Second Affiliated Hospital of Guangzhou Medical University from January 2017 to December 2018,The efficacy and significance of the treatment of the central adrenal vein.MethodsFrom January 2017 to December 2018,the preoperative general clinical data,intraoperative video and intraoperative clinical data,and postoperative clinical data of 74 patients undergoing retroperitoneal laparoscopic adrenalectomy were collected.It was retrospectively analyzed.Patients were divided into observation group and control group according to different methods of treatment of central adrenal vein in operation.In the observation group,the patient was freed to the renal hilum during operation,and the central adrenal gland was separated,exposed,clipped and disconnected from the central adrenal vein according to the central adrenal vein and the renal hilum,and then the affected adrenal gland was completely removed.In the control group,the adrenal gland was separated first,and finally the central vein was freed and clipped off.The statistical content includes preoperative general clinical data(including gender,age,tumor location,tumor diameter,preoperative hypertension,etc.)in the two groups.The video recording and intraoperative clinical data(including intraoperative blood loss and blood transfusion)Conditions,operation time,intraoperative blood pressure fluctuations),postoperative recovery(including postoperative recovery time,postoperative bedtime,removal of drainage tube,postoperative analgesic use,postoperative discharge time),concurrent The incidence of disease,long-term recovery after surgery,recurrence and postoperative pathological types of the two groups of patients.Statistical analysis was performed on the two groups of data using SPSS 25.0.The data of the two groups were compared or not,and the advantages and disadvantages of the two groups were analyzed.ResultsA total of 74 patients were collected and analyzed,including 38 in the observation group and 36 in the control group.There were no significant differences in preoperative general clinical data(including gender composition,patient age,tumor location,preoperative hypertension,tumor diameter,etc.)between the two groups(P>0.05).Laparoscopic surgery was successful in both groups.None of the patients underwent open surgery and all were discharged after surgery.Comparison of intraoperative clinical data: The operation time of the observation group and the control group was 93.95±18.29 min vs 113.14±35.27 min,P<0.05.The intraoperative blood loss of the observation group and the control group was 60.14±27.18 ml vs 76.11±36.45 ml,P<0.05.There was no blood transfusion in all patients in both groups.Comparison of intraoperative blood pressure fluctuations between the two groups: 4 of the 38 patients in the observation group(10.5%)had intraoperative blood pressure fluctuations exceeding 20 mmHg;in the control group,11 patients(30.5%)had intraoperative blood pressure fluctuations ? 20 mmHg,P < 0.05.Comparison of postoperative recovery between the two groups: the time to rest in bed after surgery was 2.39±1.08 d vs 3.08±1.59 d,P<0.05.There were no significant differences between the two groups in terms of postoperative recovery time,postoperative drainage time,postoperative analgesic use,and postoperative discharge time.There was no significant difference in the incidence of complications,long-term postoperative blood pressure recovery,and recurrence between the two groups.ConclusionsAccurate anatomical exposure and free adrenal central vein are safe and reliable during retroperitoneal laparoscopic adrenalectomy,which is beneficial to reduce intraoperative bleeding;shorten operation time,reduce secondary injury,make the surgery safer and shorten learning curve.Retroperitoneal laparoscopic adrenalectomy(RLA)is safe and reliable in adrenalectomy.