Abstract：
Background: With the development of minimally invasive techniques, laparoscopic adrenalectomy (LA) has become the standard for the treatment of adrenal surgical diseases, but conversion to open adrenalectomy (OA) is also necessary in some cases. The purpose of this study was to investigate the risk factors for conversion from LA to OA. Methods: A retrospective study was performed on 911 patients who were diagnosed with adrenal tumors and underwent LA in the Department of Urology, Second Hospital of Lanzhou University from January 2013 to December 2021. According to the surgical methods, the patients were divided into the laparoscopic group (n = 873) and the conversion group (n = 38). Logistic regression was used to analyze the independent risk factors of conversion, and the logistic regression equation was established to predict the probability of conversion. Results: In this study, 38 patients (4.17%) were converted to open. In the univariate analysis, body mass index (P = .037), tumor side (P < .001), tumor size (P < .001), surgical approach (P < .001), and histological type (P = .006) were significantly associated with conversion. In the multivariate analysis, tumor diameter >7 cm (odds ratio = 2.835, 95% confidence interval 1.096-7.335; P = .032), transabdominal approach (odds ratio = 2.400, 95% confidence interval 1.136-5.074; P = .022), pheochromocytoma (odds ratio = 5.018, 95% confidence interval 1.964-12.822; P = .001), and malignant tumor (odds ratio = 17.781, 95% confidence interval 4.156-76.075; P < .001) were independent risk factors for transition opening. The logistic regression equation showed good power to predict conversion. Conclusion: Tumor size, surgical approach, and histological type were predictive factors for conversion from a laparoscopic to an open procedure. Preoperative evaluation of these characteristics is of great value for clinicians to evaluate the risk of conversion and make a surgical plan. It can not only reduce the conversion rate but also help to improve the intraoperative situation and shorten the length of hospital stays.
摘要：
背景:随着微创技术的发展,腹腔镜肾上腺切除术(LA)已成为治疗肾上腺外科疾病的标准,但在某些情况下，转换为开放性肾上腺切除术（OA）也是必要的。这项研究的目的是调查从LA转变为OA的危险因素。方法:对911例诊断为肾上腺肿瘤并在泌尿外科行LA的患者进行回顾性研究,2013年1月至2021年12月，兰州大学第二医院。根据手术方法,将患者分为腹腔镜组（n=873）和转换组（n=38）。Logistic回归分析转化的独立危险因素,建立Logistic回归方程预测转化概率。结果:在这项研究中,38例(4.17%)患者转为开放。在单变量分析中，体重指数（P=0.037），肿瘤侧（P<.001），肿瘤大小（P<.001），手术入路（P<.001），和组织学类型（P=.006）与转换显着相关。在多变量分析中，肿瘤直径>7厘米（比值比=2.835，95％置信区间1.096-7.335;P=.032），经腹入路（比值比=2.400，95%置信区间1.136-5.074；P=.022），嗜铬细胞瘤(比值比=5.018，95%置信区间1.964-12.822；P=.001)，和恶性肿瘤（比值比=17.781，95％置信区间4.156-76.075；P<.001）是过渡开放的独立危险因素。逻辑回归方程显示出良好的转换预测能力。结论：肿瘤大小，手术方法,和组织学类型是腹腔镜转换为开腹手术的预测因素.这些特点的术前评价对临床医师评价转换风险和制订手术计划具有主要价值。它不仅可以降低转换率，还有助于改善术中情况，缩短住院时间。
