Pietrabissa A, Cuschieri A, Carobbi A, Boggi U, Vistoli F, Mosca F
Divisione di Chirurgia Generale, Dipartimento di Oncologia, Università di Pisa, Ospedale di Cisanello, via Paradisa 2, 56124 Pisa, Italy.
Surg Endosc. 1999 Mar;13(3):298-302. doi: 10.1007/s004649900970.
Endoscopic adrenalectomy has been recommended for the treatment of several benign adrenal diseases. The safety of this procedure largely depends on a careful surgical dissection and appropriate hemostatic technique. An established slipknotting technique was employed to control the main adrenal vein in a consecutive series of 14 patients undergoing endoscopic adrenalectomy. The operative steps to ligate the adrenal pedicle are described. A Medline search also was conducted to identify all reported bleeding episodes associated with this procedure. All attempted ligatures of the main adrenal vein were completed successfully by the described technique, and none of our patients required perioperative blood transfusion. Twenty-eight episodes of bleeding collected from the literature were analyzed. Hemorrhagic accidents related to dislodgement of clips were documented at least in three patients. The cause of bleeding was unspecified in 10 patients. Extracorporeal ligation of the main adrenal vein is feasible, safe, and advisable to prevent the occurrence of hemorrhage during endoscopic adrenalectomy.
内镜下肾上腺切除术已被推荐用于治疗多种肾上腺良性疾病。该手术的安全性很大程度上取决于仔细的手术解剖和适当的止血技术。在连续14例接受内镜下肾上腺切除术的患者中，采用一种成熟的滑结技术来控制肾上腺主要静脉。描述了结扎肾上腺蒂的手术步骤。还进行了医学文献检索，以确定与该手术相关的所有报道的出血事件。通过所述技术成功完成了所有对肾上腺主要静脉的结扎尝试，我们的患者均无需围手术期输血。对从文献中收集到的28例出血事件进行了分析。至少在3例患者中记录到与夹子移位相关的出血事故。10例患者出血原因不明。肾上腺主要静脉的体外结扎对于预防内镜下肾上腺切除术期间出血的发生是可行、安全且可取的。
