Lin Yi, Li Liming, Zhu Jun, Qiang Wanming, Makiyama Kazuhide, Kubota Yoshinobu
Department of Urology, Tianjin Medical University General Hospital, Institute of Urology, Tianjin, China.
Int J Urol. 2007 Oct;14(10):910-3. doi: 10.1111/j.1442-2042.2007.01860.x.
Laparoscopic adrenalectomy has become an effective option for aldosteronoma. We evaluated the retroperitoneal approach with regard to safety, efficacy, invasiveness and cost-benefit ratio in patients with primary aldosteronism.
Between July 1999 and June 2005, we carried out a total of 195 retroperitoneoscopic adrenalectomies (RA) in one hospital, including 108 on the left and 87 on the right, in 78 men and 113 women aged 20-78 years (mean age 48.2 years) with aldosteronoma. Average adrenal tumor size was 16 mm (range 10-32 mm). The 195 operations were divided into 10 groups of 20 operations each, and the mean duration and estimated blood loss for each group were compared.
The mean operating time and intraoperative blood loss in RA were 93.2 +/- 37.4 (45-210) min and 68.5 +/- 53.2 (5-210) mL, respectively. Compared to group 1 (cases 1-20), a statistically significant decrease in operative time and estimated blood loss were seen in and after group 4 (>or= case 61, 94.5 +/- 30.3 vs 139.2 +/- 44.7 min, P < 0.01), and in and after group 5 (>or= case 81, 67.5 +/- 50.5 vs 120.5 +/- 60.9 mL, P < 0.01), respectively. No differences were found in duration of surgery and estimated blood loss between left and right sided tumors (P > 0.05). The mean postoperative hospital stay was 4.5 +/- 1.2 days. Postoperative complications, including hematoma and wound infection, occurred in 4.1% of patients.
Retroperitoneoscopic adrenalectomy for aldosteronoma is a safe, effective, and minimally invasive approach with an advantageous cost-benefit ratio. With accumulated experience, it can expedite the learning curve for RA.
腹腔镜肾上腺切除术已成为醛固酮瘤的一种有效治疗选择。我们评估了后腹腔镜手术在原发性醛固酮增多症患者中的安全性、有效性、侵袭性及成本效益比。
1999年7月至2005年6月期间，我们在一家医院共进行了195例后腹腔镜肾上腺切除术（RA），其中左侧108例，右侧87例，患者年龄20 - 78岁（平均年龄48.2岁），包括男性78例，女性113例，均患有醛固酮瘤。肾上腺肿瘤平均大小为16 mm（范围10 - 32 mm）。195例手术分为10组，每组20例，比较每组的平均手术时间和估计失血量。
RA的平均手术时间和术中失血量分别为93.2±37.4（45 - 210）分钟和68.5±53.2（5 - 210）毫升。与第1组（病例1 - 20）相比，第4组（≥病例61）及以后手术时间和估计失血量有统计学显著减少（94.5±30.3对139.2±44.7分钟，P < 0.01），第5组（≥病例81）及以后估计失血量有统计学显著减少（67.5±50.5对120.5±60.9毫升，P < 0.01）。左右侧肿瘤的手术时间和估计失血量无差异（P > 0.05）。术后平均住院时间为4.5±1.2天。术后并发症包括血肿和伤口感染，发生率为4.1%。
后腹腔镜肾上腺切除术治疗醛固酮瘤是一种安全、有效且微创的方法，具有有利的成本效益比。随着经验的积累，可加快RA的学习曲线。
