Brunt L M
Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surg Endosc. 2002 Feb;16(2):252-7. doi: 10.1007/s00464-001-8302-8. Epub 2001 Nov 16.
This study was conducted to determine whether laparoscopic adrenalectomy (LA) has had a positive impact on the incidence and nature of adrenalectomy-related complications, as compared with the prelaparoscopic era.
All English language reports of patients undergoing either open adrenalectomy (OA) or LA from 1980 to 2000 were identified by Medline search. Reports were analyzed for the frequency and type of complications, with a minimum of 10 cases or studies required for inclusion. Complications were stratified by type and/or organ system involved, and groups were compared statistically using generalized linear model methods.
Complications were tabulated from 50 studies of LA involving 1,522 patients and 48 studies of OA comprising 2,273 patients. Among the reports, 22 compared LA and OA within a single institution. The total reported complication rate was 25.2% with LA versus 10.9% with OA (p < or = 0.0001). The incidence of bleeding complications was higher with LA (4.7%) than OA (3.7%) (p < or = 0.0001). As compared with LA, OA had a significantly higher incidence of associated organ injury (2.4% vs 0.7%), mainly to the spleen, and more wound (6.9% vs 1.4%), pulmonary (5.5% vs 0.9%), cardiac (1.6% vs 0.3%), and infectious (5.8% vs 1.6%) complications (p < or = 0.0001). No significant differences in gastrointestinal, thromboembolic, or neurologic complications were seen. The mortality rate was 0.3% after LA and 0.9% after OA. The difference was not significant.
Laparoscopic adrenalectomy has resulted in fewer adrenalectomy-related complications than seen historically with OA. Fewer wound and pulmonary complications and a reduced incidence of incidental splenectomy are primarily responsible for this improved outcome.
本研究旨在确定与腹腔镜手术前时代相比，腹腔镜肾上腺切除术（LA）对肾上腺切除术相关并发症的发生率及性质是否产生了积极影响。
通过医学文献数据库检索，找出1980年至2000年期间所有关于接受开放性肾上腺切除术（OA）或LA患者的英文报告。对报告中的并发症频率和类型进行分析，纳入标准为至少10例病例或研究。并发症按所涉及的类型和/或器官系统进行分层，并使用广义线性模型方法对组间进行统计学比较。
整理了50项关于LA的研究（涉及1522例患者）和48项关于OA的研究（包含2273例患者）中的并发症情况。在这些报告中，22项在单一机构内对LA和OA进行了比较。报告的总并发症发生率LA为25.2%，OA为10.9%（p≤0.0001）。LA的出血并发症发生率（4.7%）高于OA（3.7%）（p≤0.0001）。与LA相比，OA的相关器官损伤发生率显著更高（2.4%对0.7%），主要是脾脏损伤，且伤口（6.9%对1.4%）、肺部（5.5%对0.9%）、心脏（1.6%对0.3%）和感染（5.8%对1.6%）并发症更多（p≤0.0001）。在胃肠道、血栓栓塞或神经系统并发症方面未见显著差异。LA后的死亡率为0.3%，OA后为0.9%。差异无统计学意义。
与历史上的OA相比，腹腔镜肾上腺切除术导致的肾上腺切除术相关并发症更少。伤口和肺部并发症减少以及意外脾切除术发生率降低是这一改善结果的主要原因。
