Maccabee D L, Jones A, Domreis J, Deveney C W, Sheppard B C
Department of Surgery, Oregon Health and Sciences University, L223A, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA.
Surg Endosc. 2003 Oct;17(10):1566-9. doi: 10.1007/s00464-002-8746-5. Epub 2003 Jul 21.
We sought to determine the learning curve for laparoscopic adrenalectomy (LA), current use of the procedure, and if indications for adrenalectomy had changed in the past decade.
A retrospective chart review was performed for all adrenalectomies after 1990. Practicing community surgeons in Oregon were mailed a questionnaire.
Seventy-five LAs were performed at the Oregon Health and Sciences University and Portland VA Medical Center. Average operating room (OR) time was 161 min and average estimated blood loss (EBL) was 84 ml. There were four complications and two conversions. Comparing the first 20 to the last 20 patients, OR times were 154 vs 159 min (not significant), and EBL was 102 vs 47 ml ( p < 0.05). There were two vs one complications ( p > 0.05) and one conversion each. Most residents completed less than two procedures during training, and community surgeons performed none during training. Of 17 currently performing LA, 14 had postresidency training. Open technique was used more often for hormonal ablation and malignancy.
Operative time and complications do not decrease with experience, but EBL does. Few, if any, residents acquire enough experience to perform LA in practice. The procedure is performed laparoscopically more often for benign disease.
我们试图确定腹腔镜肾上腺切除术（LA）的学习曲线、该手术目前的应用情况，以及在过去十年中肾上腺切除术的指征是否发生了变化。
对1990年以后所有的肾上腺切除术进行回顾性病历审查。向俄勒冈州的执业社区外科医生邮寄了一份调查问卷。
俄勒冈健康与科学大学和波特兰退伍军人事务医疗中心共进行了75例LA。平均手术时间为161分钟，平均估计失血量（EBL）为84毫升。有4例并发症和2例中转开腹。比较前20例和后20例患者，手术时间分别为154分钟和159分钟（无显著性差异），EBL分别为102毫升和47毫升（p<0.05）。并发症分别为2例和1例（p>0.05），中转开腹各1例。大多数住院医师在培训期间完成的手术少于2例，社区外科医生在培训期间未进行该手术。在目前进行LA的17名医生中，14名在住院医师培训后接受过相关训练。开放手术更多用于激素消融和恶性肿瘤。
手术时间和并发症并不会随着经验的增加而减少，但EBL会减少。很少有住院医师（如果有的话）能获得足够的经验在实际中进行LA。该手术更多用于良性疾病的腹腔镜治疗。
