Walz Martin K, Alesina Piero F, Wenger Frank A, Deligiannis Anastasios, Szuczik Eduard, Petersenn Stephan, Ommer Andreas, Groeben Harald, Peitgen Klaus, Janssen Onno E, Philipp Thomas, Neumann Hartmut P H, Schmid Kurt W, Mann Klaus
Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Essen, Germany.
Surgery. 2006 Dec;140(6):943-8; discussion 948-50. doi: 10.1016/j.surg.2006.07.039.
The posterior retroperitoneoscopic adrenalectomy is less popular than the laparoscopic transabdominal method. Due to the direct approach to the adrenal glands, however, the posterior retroperitoneal access is easy to use and may offer advantages not available with other endoscopic procedures for adrenalectomy.
Between July 1994 and March 2006, we performed 560 adrenalectomies (right side: n = 258; left side: n = 302) by the posterior retroperitoneoscopic approach in 520 patients (200 male, 320 female; age, 10 to 83 years). Of the 520 patients, 21 suffered from Cushing's disease, 499 patients had adrenal tumors (157 Conn's adenomas, 120 pheochromocytomas [13 bilateral], 110 Cushing's adenomas [6 bilateral], and 112 other tumors). Tumor size ranged from 0.5 to 10 cm (mean, 2.9 +/- 1.7 cm). The procedures were performed with the patients in the prone position usually with 3 trocars.
Mortality was zero. Conversions to open or laparoscopic lateral surgery were necessary in 9 patients (1.7%). Major complications occurred in 1.3% of patients, minor complications in 14.4%. Mean operating time was 67 +/- 40 min and declined significantly (P < .001) from the early procedures (106 +/- 46 min) to the later operations (40 +/- 15 min).
The posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. In experienced hands, this method represents the ideal approach in adrenal surgery.
后腹腔镜肾上腺切除术不如腹腔镜经腹手术普及。然而，由于可直接到达肾上腺，后腹腔镜入路易于操作，可能具有其他肾上腺切除内镜手术所没有的优势。
1994年7月至2006年3月，我们采用后腹腔镜入路对520例患者（男200例，女320例；年龄10至83岁）实施了560例肾上腺切除术（右侧：n = 258；左侧：n = 302）。520例患者中，21例患有库欣病，499例有肾上腺肿瘤（157例Conn腺瘤，120例嗜铬细胞瘤[13例双侧]，110例库欣腺瘤[6例双侧]，112例其他肿瘤）。肿瘤大小为0.5至10 cm（平均2.9±1.7 cm）。手术通常在患者俯卧位下使用3个套管针进行。
死亡率为零。9例患者（1.7%）需要转为开放手术或腹腔镜侧方手术。主要并发症发生率为1.3%，次要并发症发生率为14.4%。平均手术时间为67±40分钟，从早期手术（106±46分钟）到后期手术（40±15分钟）显著下降（P <.001）。
后腹腔镜肾上腺切除术是一种安全、快速的手术。在经验丰富的医生手中，该方法是肾上腺手术的理想选择。
