Ortega Joaquín, Sala Carlos, Garcia Stephanie, Lledo Salvador
Department of General Surgery, Hospital Clinico Universitario, Valencia, Spain.
J Laparoendosc Adv Surg Tech A. 2002 Feb;12(1):1-5. doi: 10.1089/109264202753486858.
Nowadays, laparoscopy has become the approach of choice for adrenalectomy, especially in cases of benign tumors <6 cm. The authors have studied, in a retrospective trial, two groups of patients who have undergone an adrenalectomy: 10 consecutive patients operated on by an open approach and 10 consecutive patients operated on by laparoscopy.
Laparoscopic adrenalectomies were performed via a transabdominal lateral approach, whereas open adrenalectomies were performed via an anterior transabdominal or posterior retroperitoneal approach. Clinical outcomes were recorded, and special attention was paid to the costs of both techniques, collecting economic data from the costs in outpatient visits, blood and urine tests, diagnostic imaging, hospital admissions prior to surgery, hospital admission for surgery, and surgical expenses.
Operative time (110 vs 123 minutes), length of postoperative stay (3.7 vs 5.8 days), and time to oral intake (1 vs 2 days) were significantly lower in the laparoscopic group. From the economic point of view, however, there were no significant differences between laparoscopic and open groups (6,306 vs 7,581), and only surgical inhospital stay costs were significantly lower in the laparoscopic series (742 vs 1,191). All the costs generated by surgery (hospital admission for surgery plus surgical expenses) were smaller in the laparoscopic group but constituted only a small part of the general expenses for these patients. The more expensive part of the budget for every patient was the hospital admissions prior to surgery for diagnosis or preoperative treatment.
Laparoscopy is a safe and comfortable approach for adrenalectomy and should be the technique of choice. From the economic point of view, laparoscopic adrenalectomy is cheaper than open adrenalectomy, but in all cases, surgical costs are only a minimal part of the budget, and the greater savings must come from the reduction in the presurgical diagnostic process.
如今，腹腔镜手术已成为肾上腺切除术的首选方法，尤其是对于直径小于6cm的良性肿瘤。作者在一项回顾性试验中研究了两组接受肾上腺切除术的患者：连续10例采用开放手术方式的患者和连续10例采用腹腔镜手术的患者。
腹腔镜肾上腺切除术通过经腹侧方入路进行，而开放肾上腺切除术通过经腹前路或后腹膜后入路进行。记录临床结果，并特别关注两种技术的成本，从门诊就诊、血液和尿液检查、诊断性影像学检查、手术前住院、手术住院以及手术费用中收集经济数据。
腹腔镜组的手术时间（110分钟对123分钟）、术后住院时间（3.7天对5.8天）和开始经口进食时间（1天对2天）明显更短。然而，从经济角度来看，腹腔镜组和开放手术组之间没有显著差异（6306对7581），只有腹腔镜组的手术住院费用明显更低（742对1191）。腹腔镜组手术产生的所有费用（手术住院费用加上手术费用）更低，但仅占这些患者总费用的一小部分。每位患者预算中较昂贵的部分是手术前用于诊断或术前治疗的住院费用。
腹腔镜手术是一种安全且舒适的肾上腺切除方法，应作为首选技术。从经济角度来看，腹腔镜肾上腺切除术比开放肾上腺切除术便宜，但在所有情况下，手术费用仅占预算的极小部分，更大的节省必须来自术前诊断过程的减少。
