Gullà N, Patriti A, Lazzarini F, Capitanucci L, Fabbri B, Tristaino B
Università degli Studi, Perugia, Dipartimento di Scienze Chirurgiche, Sezione di Chirurgia Generale e d'Urgenza, Policlinico Monteluce, Perugia.
Minerva Chir. 2000 Jul-Aug;55(7-8):569-74.
The more wide spread laparoscopic technique to operate on the adrenal gland is transabdominal approach with a lateral flank adrenalectomy. However, the transabdominal anterior approach can be a sure and safe alternative in selected patients.
From 1997 to 1999, 18 selected patients underwent laparoscopic anterior adrenalectomy. Mean age was 43 years (range 25-63) with a male/female ratio of 1:1. Indications were Conn's adenoma in 10 patients, pheochromocytoma in 3 cases, Cushing syndrome in 1 and incidentaloma in 4. All the procedures were carried out laparoscopically and only one patient required conversion to an open adrenalectomy for clear signs of malignancy. The mean time for adrenalectomy was 140 minutes and the shorter times were recorded in the right-sided procedures (mean time 84 minute). Estimated blood loss was minimal and no transfusion was done. There were no postoperative complications related to the surgical technique and the hospital stay was 4 days in average.
Our data confirm, according with other authors, that this method is feasible in selected patients. Longer times recorded for the left-sided lesions were due to the more difficult dissection required to gain the left adrenal gland.
Transabdominal adrenalectomy with patient in the supine position is feasible, but its use is restricted to the cases with suspect bilateral or multifocal pheochromocytoma, to patients with concomitant abdominal pathologies that can be operated on laparoscopically, to surgeons who prefer to have a frontal view of the operative field.
肾上腺手术中应用更为广泛的腹腔镜技术是经腹途径行侧腰部肾上腺切除术。然而，经腹前路手术在特定患者中是一种可靠且安全的替代方法。
1997年至1999年，18例特定患者接受了腹腔镜前路肾上腺切除术。平均年龄43岁（范围25 - 63岁），男女比例为1:1。手术指征为：10例Conn腺瘤，3例嗜铬细胞瘤，1例库欣综合征，4例肾上腺意外瘤。所有手术均通过腹腔镜进行，只有1例患者因明确的恶性征象而转为开放性肾上腺切除术。肾上腺切除术的平均时间为140分钟，右侧手术时间较短（平均84分钟）。估计失血量极少，未进行输血。无与手术技术相关的术后并发症，平均住院时间为4天。
我们的数据与其他作者一致，证实该方法在特定患者中是可行的。左侧病变手术时间较长是由于显露左侧肾上腺所需的解剖操作更为困难。
患者仰卧位的经腹肾上腺切除术是可行的，但其应用仅限于怀疑双侧或多灶性嗜铬细胞瘤的病例、伴有可通过腹腔镜手术的腹部病变的患者以及倾向于直视手术视野的外科医生。
