Kotzampassakis N, Maweja S, Defechereux T, Meurisse M, Hamoir E
Department of endocrine surgery, University of Liège, CHU Sart-Tilman, Liège, Belgium.
Acta Chir Belg. 2005 Apr;105(2):156-60.
To review our personal experience of the last 10 years with adrenal surgery in order to define the indications of laparoscopic adrenalectomy (LA) and open adrenalectomy (OA), respectively.
From November 1993 to June 2003, we performed 105 adrenalectomies on 97 patients (29 males and 68 females). The lesions resected were preoperatively considered non-secreting in 47 cases (45%) and hormonally active in 58 cases (55%). In 78 patients (80%), LA was performed and 84 adrenal glands were resected. In 19 patients (20%), OA was considered the best modality of resection and 21 adrenal glands were resected. The average tumour size was 37.2 mm (range 25-90) in LA group and 82.6 mm (30-260) in the OA group. All the LA were performed using a trans-peritoneal approach. Depending on the particularities of the lesions and of the patients, the OA were performed by anterior or lumbar incisions.
There was no mortality. Conversion from LA to open surgery was necessary in two patients. Mean operating time was 110 minutes for LA and 135 minutes for OA. Two (2.6%) patients suffered complications after LA and 4 (19%) after OA.
In our experience, trans-peritoneal LA proved to be a safe and reliable procedure for benign adrenal disease. In our institution, it has become the gold standard technique for the resection of adrenal tumours, except for those suspected or proven malignant.
回顾我们过去10年肾上腺手术的个人经验，以分别明确腹腔镜肾上腺切除术（LA）和开放性肾上腺切除术（OA）的适应证。
1993年11月至2003年6月，我们对97例患者（29例男性，68例女性）实施了105例肾上腺切除术。术前认为切除的病变中，47例（45%）无分泌功能，58例（55%）有激素活性。78例患者（80%）接受了LA，切除了84个肾上腺。19例患者（20%）认为OA是最佳的切除方式，切除了21个肾上腺。LA组肿瘤平均大小为37.2mm（范围25 - 90），OA组为82.6mm（30 - 260）。所有LA均采用经腹途径。根据病变和患者的具体情况，OA通过前入路或腰入路进行。
无死亡病例。2例患者需要由LA转为开放手术。LA的平均手术时间为110分钟，OA为135分钟。LA后2例（2.6%）患者出现并发症，OA后4例（19%）出现并发症。
根据我们的经验，经腹LA被证明是治疗良性肾上腺疾病的一种安全可靠的方法。在我们机构，它已成为切除肾上腺肿瘤的金标准技术，但怀疑或证实为恶性的肿瘤除外。
