Castillo Octavio A, Vitagliano Gonzalo, Secin Fernando P, Kerkebe Marcelo, Arellano Leonardo
Section of Endourology and Laparoscopic Urology, Clínica Santa María, Santiago de Chile, Chile.
Urology. 2008 Jun;71(6):1138-41. doi: 10.1016/j.urology.2007.12.019. Epub 2008 Mar 12.
To examine the impact of adrenal tumor size on perioperative morbidity and postoperative outcomes in patients undergoing laparoscopic adrenalectomy.
A total of 227 laparoscopic adrenalectomies were divided in three groups according to size as estimated by pathologic specimen maximum diameter: less than 6 cm (group 1, n = 140), between 6 and 7.9 cm (group 2, n = 47), and equal to or larger than 8 cm (group 3, n = 40). We prospectively recorded and analyzed clinical and pathologic data.
Average operative time was 60 minutes (range, 50 to 90 minutes) for group 1, 75 minutes (range, 65 to 105 minutes) for group 2, and 80 minutes (range, 65 to 120 minutes) for group 3. Estimated blood loss, median (interquartile range) was 50 mL (range, 20 to 100 mL), 100 mL (range, 48 to 225 mL), and 100 mL (range, 50 to 475 mL) for groups 1, 2, and 3, respectively. We observed a total of 10, 4, and 4 complications in groups 1, 2, and 3, respectively. Average hospital stay was 2 days (range, 2 to 3 days), 2 days (range, 2 to 3 days), and 3 days (range, 2 to 4 days), respectively, for groups 1, 2, and 3. Operative time, average blood loss, and mean hospital stay were significantly higher (P <or=0.05) for group 3 compared with group 1.
Laparoscopic adrenalectomy in large adrenal masses (8 cm or greater) is associated with significantly longer operative time, increased blood loss, and longer hospital stay, without affecting perioperative morbidity.
探讨肾上腺肿瘤大小对接受腹腔镜肾上腺切除术患者围手术期发病率及术后结局的影响。
根据病理标本最大直径估计的大小，将227例腹腔镜肾上腺切除术分为三组：小于6 cm（第1组，n = 140）、6至7.9 cm（第2组，n = 47）、等于或大于8 cm（第3组，n = 40）。我们前瞻性地记录并分析了临床和病理数据。
第1组平均手术时间为60分钟（范围50至90分钟），第2组为75分钟（范围65至105分钟），第3组为80分钟（范围65至120分钟）。第1、2、3组估计失血量中位数（四分位间距）分别为50 mL（范围20至100 mL）、100 mL（范围48至225 mL）和100 mL（范围50至475 mL）。第1、2、3组分别共观察到10例、4例和4例并发症。第1、2、3组平均住院时间分别为2天（范围2至3天）、2天（范围2至3天）和3天（范围2至4天）。与第1组相比，第3组的手术时间、平均失血量和平均住院时间显著更长（P≤0.05）。
大肾上腺肿块（8 cm或更大）的腹腔镜肾上腺切除术与显著更长手术时间、更多失血量和更长住院时间相关，但不影响围手术期发病率。
