Smith C D, Weber C J, Amerson J R
Department of Surgery, Division of Gastrointestinal and General Surgery, Emory University School of Medicine, 1364 Clifton Road NE, Suite H122, Atlanta Georgia 30322, USA.
World J Surg. 1999 Apr;23(4):389-96. doi: 10.1007/pl00012314.
Nearly 600 cases of laparoscopic adrenalectomy have been described in the world literature, documenting the safety and effectiveness of the procedure. Comparative studies have demonstrated the advantages of the laparoscopic approach when compared to traditional open approaches to adrenalectomy, documenting a more rapid and comfortable recovery, shorter hospitalization, and fewer complications. Several techniques of laparoscopic adrenalectomy have been described. We prefer the transabdominal approach in the lateral decubitus position. Herein we report our experience with 28 adrenalectomies using this approach. Indications for adrenalectomy have been hyperaldosteronism (9), hypercortisolism (4), pheochromocytoma (3), incidentaloma (6), metastasis (3), lymphoma (1), angiomyolipoma (1), other (1). Average tumor size was 3.3 cm (1. 4-8.3 cm). Average operative time was 152 minutes (110-210 minutes), with left adrenalectomy taking slightly longer to perform than on the right (156 vs. 145 minutes). There were no intraoperative complications and one conversion to open adrenalectomy for a large metastatic lung cancer found to be invading the liver. One patient experienced left rib pain from a cannula site immediately at the costal margin. There were no other complications. Average length of hospitalization was 2.3 days (1-6 days). With this and others' experience, laparoscopic adrenalectomy has become the gold standard for adrenalectomy. This manuscript reviews the literature on laparoscopic adrenalectomy and describes the transabdominal lateral approach.
世界文献中已报道了近600例腹腔镜肾上腺切除术，证明了该手术的安全性和有效性。比较研究表明，与传统开放性肾上腺切除术相比，腹腔镜手术具有优势，恢复更快、更舒适，住院时间更短，并发症更少。已经描述了几种腹腔镜肾上腺切除术技术。我们更倾向于采用侧卧位经腹入路。在此，我们报告使用该方法进行28例肾上腺切除术的经验。肾上腺切除术的适应证包括醛固酮增多症（9例）、皮质醇增多症（4例）、嗜铬细胞瘤（3例）、偶发瘤（6例）、转移瘤（3例）、淋巴瘤（1例）、血管平滑肌脂肪瘤（1例）、其他（1例）。肿瘤平均大小为3.3 cm（1.4 - 8.3 cm）。平均手术时间为152分钟（110 - 210分钟），左侧肾上腺切除术的手术时间略长于右侧（156分钟对145分钟）。术中无并发症，1例因发现巨大转移性肺癌侵犯肝脏而转为开放性肾上腺切除术。1例患者肋缘下套管穿刺部位立即出现左肋疼痛。无其他并发症。平均住院时间为2.3天（1 - 6天）。基于我们及他人的经验，腹腔镜肾上腺切除术已成为肾上腺切除术的金标准。本文回顾了腹腔镜肾上腺切除术的文献，并描述了经腹侧入路。
