Nakagawa Ken, Murai Masaru
Department of Urology, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Biomed Pharmacother. 2002;56 Suppl 1:107s-112s. doi: 10.1016/s0753-3322(02)00232-9.
A decade has elapsed since laparoscopic adrenalectomy was first performed in 1992. Accumulated experiences of laparoscopic adrenalectomy have shown superior results to treat small functional benign tumors and make the indication expand to large tumors, pheochromocytomas and localized malignant tumors. Following the initially established transperitoneal approach, which includes anterior and lateral approaches, the retroperitoneal lateral flank and posterior lumber approaches have been performed. Each approach has advantages and disadvantages. The transperitoneal approach supplies a large operative field, many anatomical landmarks and easy handling. But it causes post-operative irritability and it is very difficult to perform after previous upper abdominal surgery. The retroperitoneal approach can be performed even after previous abdominal surgery and patients may be more comfortable after the operation. However, the narrow working space and the lack of anatomical landmarks may increase the rate of intra-operative complications and the rate of conversion to open surgery. Although there is no clear preference between transperitoneal and retroperitoneal approaches, the transperitoneal approach is commonly employed and the transperitoneal anterior approach seems to be the easiest one for right adrenal tumors and the transperitoneal lateral approach for left adrenal tumors. The shorter convalescence with laparoscopic adrenalectomy as compared with open adrenalectomy has been accepted and lower morbidity from laparoscopic adrenalectomy has been achieved. The operative time has been shortened to the level of open adrenalectomy. Less blood loss, less pain and better cosmesis are absolute advantages for the patients. Laparoscopic adrenalectomy is now the gold standard for the treatment of adrenal tumors.
自1992年首次开展腹腔镜肾上腺切除术以来，已经过去了十年。腹腔镜肾上腺切除术积累的经验表明，在治疗小型功能性良性肿瘤方面效果更佳，并且其适应证已扩展至大型肿瘤、嗜铬细胞瘤和局限性恶性肿瘤。在最初确立的经腹腔途径（包括前路和侧路）之后，又开展了腹膜后外侧和后腰部途径。每种途径都有其优缺点。经腹腔途径提供了较大的手术视野、众多解剖标志且操作简便。但它会导致术后不适，并且在上腹部既往手术后很难实施。腹膜后途径即使在既往腹部手术后也能进行，而且患者术后可能感觉更舒适。然而，狭小的工作空间和缺乏解剖标志可能会增加术中并发症的发生率以及中转开放手术的比例。虽然经腹腔途径和腹膜后途径之间没有明确的偏好，但经腹腔途径更为常用，经腹腔前路似乎是治疗右侧肾上腺肿瘤最简单的方法，经腹腔侧路则适用于左侧肾上腺肿瘤。与开放肾上腺切除术相比，腹腔镜肾上腺切除术恢复期更短，这一点已得到认可，并且腹腔镜肾上腺切除术的发病率更低。手术时间已缩短至开放肾上腺切除术的水平。出血量更少、疼痛减轻和美容效果更佳对患者来说绝对是优势。腹腔镜肾上腺切除术现已成为治疗肾上腺肿瘤的金标准。
