Emeriau Damien, Vallee Vincent, Tauzin-Fin Patrick, Ballanger Philippe
Service d 'Urologie, Hôpital Pellegrin, Bordeaux, France.
Prog Urol. 2005 Sep;15(4):626-31.
Laparoscopic adrenalectomy is the reference technique for the treatment of adrenal tumours. This retrospective study reports the experience of 100 consecutive laparoscopic adrenalectomies, in order to assess its indications, the incision, the morbidity and to determine the limitations of this procedure.
Between April 1994 and June 2004, 100 laparoscopic adrenalectomies were performed in 92 patients via a transperitoneal (n = 93) or retroperitoneal (n = 7) approach, with 84 unilateral and 8 bilateral adrenalectomies. The mean age was 52 years. The operative and postoperative characteristics and the functional results were evaluated.
The mean operating time was 112 min [70-175] via the retroperitoneal approach, 101 min [40-215] via the transperitoneal approach, and 135 min [120-270] for bilateral adrenalectomies. The mean tumour diameter was 44 mm [10-120 mm]. The mean blood loss was 215 ml [0-1210 ml]. Ten patients were transfused. The mean hospital stay was 3 days. Histology revealed 25 Conn adenomas, 20 cortisol-secreting adenomas and Cushing syndrome, 22 phaeochromocytomas, 20 metastases, 2 adrenal cortical adenomas, and 11 incidentalomas. Conversion to "open" surgery were necessary for technical difficulties in 6% of cases. There were 7 minor postoperative complications (7%) and 4 late complications (4%) (deep vein thrombosis, effusion, 2 local recurrences). Four patients in the group with secondary adrenal tumours were alive without recurrence 18, 20, 44 and 48 months after adrenalectomy. Antihypertensive treatment was stopped in 16 of the 25 patients operated for Conn adenoma. The mean follow-up was 31 months [5-98 months].
This technique has a low morbidity, requires minimal postoperative analgesia and a short hospitalisation. The retroperitoneal or transperitoneal approach must be chosen as a function of the patient's history and the surgeon's habits. Tumours larger than 8 cm can be resected, but with a higher morbidity. Laparoscopic adrenalectomy for malignant tumours is associated with higher morbidity.
腹腔镜肾上腺切除术是治疗肾上腺肿瘤的参考技术。本回顾性研究报告了连续100例腹腔镜肾上腺切除术的经验，以评估其适应证、切口、发病率并确定该手术的局限性。
1994年4月至2004年6月期间，对92例患者进行了100例腹腔镜肾上腺切除术，采用经腹途径（n = 93）或腹膜后途径（n = 7），其中84例为单侧肾上腺切除术，8例为双侧肾上腺切除术。平均年龄为52岁。评估了手术及术后特征和功能结果。
腹膜后途径的平均手术时间为112分钟[70 - 175]，经腹途径为101分钟[40 - 215]，双侧肾上腺切除术为135分钟[120 - 270]。平均肿瘤直径为44毫米[10 - 120毫米]。平均失血量为215毫升[0 - 1210毫升]。10例患者接受了输血。平均住院时间为3天。组织学检查显示有25例Conn腺瘤、20例分泌皮质醇腺瘤及库欣综合征、22例嗜铬细胞瘤、20例转移瘤、2例肾上腺皮质腺瘤和11例偶发瘤。6% 的病例因技术困难而转为“开放”手术。有7例轻微术后并发症（7%）和4例晚期并发症（4%）（深静脉血栓形成、积液、2例局部复发）。肾上腺继发肿瘤组中有4例患者在肾上腺切除术后18、20、44和48个月存活且无复发。25例因Conn腺瘤接受手术的患者中，16例停止了抗高血压治疗。平均随访时间为31个月[5 - 98个月]。
该技术发病率低，术后镇痛需求少，住院时间短。应根据患者病史和外科医生的习惯选择腹膜后或经腹途径。直径大于8厘米的肿瘤可以切除，但发病率较高。腹腔镜肾上腺切除术治疗恶性肿瘤的发病率较高。
