Toniato Antonio, Boschin Isabella Merante, Opocher Giuseppe, Guolo Annamaria, Pelizzo Mariarosa, Mantero Franco
Institute of Surgical Pathology, Department of Medical and Surgical Sciences, University of Padua School of Medicine, Italy.
Surgery. 2007 Jun;141(6):723-7. doi: 10.1016/j.surg.2006.10.012.
Laparoscopic adrenalectomy has become the gold standard for removing adrenal masses, but several authors still debate the role of laparoscopic adrenalectomy in pheochromocytoma. The purpose of this study was to evaluate the short- and long-term outcomes of laparoscopic versus open adrenalectomy for pheochromocytomas and to compare the feasibility and safety of laparoscopic adrenalectomy for neoplasms that are smaller than 6 cm versus those that are larger than 6 cm.
From January 1990 to December 2005, the same team in our department carried out 221 adrenalectomies in 211 patients. A total of 64 of these patients underwent 71 adrenalectomies for pheochromocytoma, 24 patients (37%) had open adrenalectomy, and 40 patients (63%) had laparoscopic adrenalectomy. Sex, age, side and size of lesion, operating time, duration of hospital stay, need for intensive care, intraoperative blood pressure variations, blood loss, postoperative analgesia, return to oral nutrition, and complications were compared among groups.
An advantage of laparoscopic adrenalectomy over open adrenalectomy was observed in mean operating time, hospital stay, need for intensive care, intraoperative hypertension, intraoperative blood loss, postoperative analgesia, and return to oral nutrition (P <or= .035 in all). The analysis of tumor size (<or=6 vs >6 cm) in laparoscopic adrenalectomy showed that none of the variables differed significantly, except for intraoperative blood loss, which was greater for the larger neoplasms (P = .007).
Laparoscopic adrenalectomy, when performed by experienced laparoscopic surgeons, is preferable to open adrenalectomy for the majority of pheochromocytomas, and as long as there is no evidence of invasion of surrounding structures, tumor size does not appear to have a profound effect on surgical outcome.
腹腔镜肾上腺切除术已成为切除肾上腺肿块的金标准，但仍有一些作者对腹腔镜肾上腺切除术在嗜铬细胞瘤治疗中的作用存在争议。本研究的目的是评估腹腔镜与开放肾上腺切除术治疗嗜铬细胞瘤的短期和长期疗效，并比较腹腔镜肾上腺切除术治疗直径小于6 cm与大于6 cm肿瘤的可行性和安全性。
1990年1月至2005年12月，我科同一团队对211例患者实施了221例肾上腺切除术。其中64例患者因嗜铬细胞瘤接受了71例肾上腺切除术，24例患者（37%）接受了开放肾上腺切除术，40例患者（63%）接受了腹腔镜肾上腺切除术。比较各组患者的性别、年龄、病变侧别和大小、手术时间、住院时间、重症监护需求、术中血压变化、失血量、术后镇痛、恢复经口营养情况及并发症。
腹腔镜肾上腺切除术在平均手术时间、住院时间、重症监护需求、术中高血压、术中失血量、术后镇痛及恢复经口营养方面均优于开放肾上腺切除术（所有P≤0.035）。对腹腔镜肾上腺切除术中肿瘤大小（≤6 cm与>6 cm）的分析显示，除术中失血量外，其他变量差异均无统计学意义，较大肿瘤的术中失血量更多（P = 0.007）。
对于大多数嗜铬细胞瘤，由经验丰富的腹腔镜外科医生实施腹腔镜肾上腺切除术优于开放肾上腺切除术，并且只要没有周围结构受侵犯的证据，肿瘤大小似乎对手术结果没有深远影响。
