机器人辅助腹腔镜与腹腔镜对肿瘤直径大于5 cm的肾上腺肿瘤治疗疗效对比

Robot-assisted laparoscopy versus conventional laparoscopy for adrenal tumors larger than 5 cm: a retrospective analysis of efficacy and safety

摘要

目的 比较机器人辅助腹腔镜肾上腺切除术（RALA）与传统腹腔镜肾上腺切除术（LA）治疗直径≥5 cm 巨大肾上腺肿瘤（LATs）的围手术期效果，以期为LATs的微创术式选择提供初步循证依据。方法 回顾性分析2019年12月-2025年6月南方医科大学南方医院泌尿外科收治的117例直径≥5 cm LATs患者的临床资料。经倾向评分匹配（PSM）后，最终纳入72例患者作为研究对象，其中36例接受 RALA（RALA 组），36例接受 LA（LA 组）。对比两组患者的手术时间、术中出血量、术后禁食时间、拔引流管时间、术后住院时间及并发症等指标。采用单因素及多因素线性回归分析手术时间的影响因素，并对嗜铬细胞瘤亚组进行分层比较分析。结果 经PSM 后，两组基线特征达到平衡。PSM 后，RALA 组与 LA 组在手术时间[125.00（97.50，162.25）min对比125.50（80.25，166.50）min，P=0.740]、术中出血量[30.00（10.00，50.00）mL对比20.00（10.00，100.00）mL，P=0.863]、术后禁食时间[16.00（13.63，20.00）h对比12.50（6.00，20.00）h，P=0.208]、拔引流管时间[3.00（2.49，3.51）d对比3.00（2.38，3.63）d，P=0.267]、术后出院时间[5.00（4.47，5.54）d对比5.00（4.17，5.84）d，P=0.417]及住院时间[13.00（10.00，17.75）d对比12.00（9.25，18.75）d，P=0.505]等围手术期指标比较，差异均无统计学意义，仅 RALA 组术后下床活动时间短于LA 组[16.00（14.93，17.07）h对比20.00（19.69，20.31）h，P=0.033]。PSM 后两组并发症发生率比较，差异无统计学意义（P=0.809）。多因素线性回归分析显示，肿瘤大小是手术时间的独立影响因素（B=16.873，95%CI：10.671～23.075，P＜0.001）。在嗜铬细胞瘤亚组中，RALA 组手术时间短于LA 组[（138.3±55.5）min vs.（180.7±85.4）min，P=0.043]。结论 RALA 与LA 治疗直径≥5 cm LATs的总体围手术期疗效与安全性相当，但 RALA 可能在促进术后早期活动、加速康复方面显示潜在获益，且在嗜铬细胞瘤亚组中该组手术时间较短；无论采用何种术式，肿瘤大小均为手术时间的独立决定因素。

Abstract

Objective To compare the perioperative outcomes of robot-assisted laparoscopic adrenalectomy（RALA）and laparoscopic adrenalectomy（LA）for large adrenal tumors with a diameter ≥5 cm，and to provide preliminary evidence for the selection of minimally invasive surgical approaches. Methods The clinical data of 117 patients with large adrenal tumors measuring ≥5 cm treated during Dec.2019 and Jun.2025 were retrospectively analyzed. After propensity score matching（PSM），72 patients were included，with 36 patients in the RALA group and 36 in the LA group. The operation time，intraoperative blood loss，postoperative fasting time，drainage tube removal time，length of hospital stay，and complications were compared between the two groups. Univariate and multivariate linear regression analyses were performed to identify the factors associated with the operation time. Subgroup analysis was further conducted in patients with pheochromocytoma. Results After PSM，baseline characteristics were balanced between the two groups. There were no significant differences between the RALA and LA groups in the operation time[125.00（97.50，162.25）min vs. 125.50（80.25，166.50）min，P=0.740]，intraoperative blood loss[30.00（10.00，50.00）mL vs.20.00（10.00，100.00）mL，P=0.863]，postoperative fasting time [16.00（13.63，20.00）h vs. 12.50（6.00，20.00）h，P=0.208]，drainage tube removal time[3.00（2.49，3.51）d vs.3.00（2.38，3.63）d，P=0.267]，postoperative discharge time[5.00（4.47，5.54）d vs.5.00（4.17，5.84）d，P=0.417]，and length of hospital stay[13.00（10.00，17.75）d vs.12.00（9.25，18.75）d，P=0.505]. The time to ambulation was shorter in the RALA group than in the LA group[16.00（14.93，17.07）h vs.20.00（19.69，20.31）h，P=0.033]. No significant difference was observed in postoperative complications between the two groups after PSM（P=0.809）. Multivariate linear regression analysis showed that tumor size was an independent factor associated with the operation time（B=16.873，95%CI：10.671-23.075，P＜0.001）. In the pheochromocytoma subgroup，the operation time was shorter in the RALA group than in the LA group [（138.3±55.5）min vs.（180.7±85.4）min，P =0.043]. Conclusion RALA and LA showed comparable overall perioperative efficacy and safety in the treatment of large adrenal tumors with a diameter ≥5 cm. RALA may have potential advantages in promoting earlier postoperative ambulation and enhanced recovery. In the pheochromocytoma subgroup，RALA was associated with a shorter operation time. Tumor size was an independent factor associated with operation time regardless of the surgical approach.

关键词

巨大肾上腺肿瘤 / 机器人辅助腹腔镜肾上腺切除术 / 腹腔镜肾上腺切除术

Key words

large adrenal tumor / robot-assisted laparoscopic adrenalectomy / laparoscopic adrenalectomy

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