Gonzalez Rodrigo, Smith C Daniel, McClusky David A, Ramaswamy Archana, Branum Gene D, Hunter John G, Weber Collin J
Emory Endosurgery Unit, General and Gastrointestinal Division, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Am Surg. 2004 Aug;70(8):668-74.
Laparoscopy has been reported advantageous over the conventional open technique for adrenalectomy. However, most comparative series include the relatively more challenging cases in the open group. The aim of this study is to assess the actual role of laparoscopy in reducing perioperative complications compared to open surgery in patients undergoing adrenalectomy. Between January 1992 and December 2002, we performed 148 adrenalectomies in 138 patients. Depending on the approach, patients were divided into laparoscopic (LA) or open adrenalectomy (OA) groups. Demographics, tumor characteristics, operative data, and outcomes were analyzed. Linear and logistic regressions identified factors influencing perioperative outcomes. Multivariate-adjusted logistic regression assessed independent relationship between factors and perioperative outcomes. A total of 78 cases were performed laparoscopically and 70 open. Patients were matched for age and sex. Tumor size was smaller (3 +/- 2 vs 5 +/- 3 cm), operative time was shorter (133 +/- 65 vs 165 +/- 100 min), estimated blood loss was less (114 +/- 152 vs 350 +/- 417 cc), length of stay was shorter (3 +/- 2 vs 7 +/- 3 days), and overall complication rate was lower (7% vs 20%) in the LA compared to the OA group. The incidence of cancer in tumors > or = 6 cm (31%) was higher than in those < 6 cm (4%). All patients with cancer underwent OA. LA was the only factor independently associated with a decreased likelihood of intraoperative bleeding and postoperative pulmonary complications. Large and malignant adrenal tumors are more frequently removed through an open approach. However, this fact has no influence on the advantages of the LA over the OA. Laparoscopy reduces perioperative adrenalectomy perioperative complication rates. It has a positive impact on intraoperative bleeding and postoperative pulmonary complications.
据报道，腹腔镜肾上腺切除术比传统开放手术更具优势。然而，大多数比较研究系列中，开放手术组纳入的病例相对更具挑战性。本研究的目的是评估与开放手术相比，腹腔镜手术在肾上腺切除术患者中减少围手术期并发症方面的实际作用。1992年1月至2002年12月期间，我们对138例患者进行了148例肾上腺切除术。根据手术方式，将患者分为腹腔镜肾上腺切除术（LA）组或开放肾上腺切除术（OA）组。分析了人口统计学、肿瘤特征、手术数据和结果。线性回归和逻辑回归确定了影响围手术期结果的因素。多变量调整逻辑回归评估了各因素与围手术期结果之间的独立关系。共进行了78例腹腔镜手术和70例开放手术。患者按年龄和性别进行匹配。与OA组相比，LA组的肿瘤体积更小（3±2 vs 5±3 cm）、手术时间更短（133±65 vs 165±100分钟）、估计失血量更少（114±152 vs 350±417 cc）、住院时间更短（3±2 vs 7±3天），总体并发症发生率更低（7% vs 20%）。肿瘤≥6 cm的患者中癌症发生率（31%）高于肿瘤<6 cm的患者（4%）。所有癌症患者均接受了OA手术。LA是唯一与术中出血和术后肺部并发症发生率降低独立相关的因素。大的和恶性肾上腺肿瘤更常通过开放手术切除。然而，这一事实并不影响LA相对于OA的优势。腹腔镜手术可降低肾上腺切除术的围手术期并发症发生率。它对术中出血和术后肺部并发症有积极影响。
