M. Skłodowska-Curie Hospital, Department of General and Transplantation Surgery, Szczecin, Poland.
Endokrynol Pol. 2010 Jan-Feb;61(1):94-101.
Laparoscopic adrenalectomy (LA) has become the standardized treatment of benign adrenal lesions over the last two decades, making the indications to open adrenalectomy (OA) limited. The purpose of this study was to show the thirty years of experience in open (OA) and laparoscopic adrenalectomy (LA) gained in one medical centre as well as to compare the results of OA and LA performed for benign adrenal lesions.
Three hundred patients underwent 127 open and 173 laparoscopic adrenalectomies between 1979 and 2009 at M. Curie Hospital in Szczecin, Poland. Analyzed factors included patients demographic data, ASA score, indication for surgery, tumour size and side, characteristics of the removed tumours, intraoperative and postoperative outcome of LA and OA, postoperative pain sensation, intraoperative and postoperative complications, and conversion rate from LA to OA. Tumours with diameter exceeding 8 cm were excluded.
There were no significant differences regarding the analyzed preoperative data in both groups of patients. The mean operative time was longer in the LA group (137 v. 82 min., p < 0.0001) and the blood loss was lower in LA group (110 v. 254 mL, p < 0.0001). The mean time until resumption of normal diet was shorter after LA (22 v. 44 h), as was the mean time until ambulation (17 v. 36 h), mean length of the hospital stay (4.6 v. 6.8 days), and mean time until return to normal activities (14 v. 23 days, p < 0.0001 for each difference). The analgesic requirement on the first and the second day postoperatively was lower in the LA group (p < 0.0001). The incidence of intraoperative and postoperative complications did not differ significantly between both analyzed groups. The rate of the conversion from LA to OA was 16%. The histopathological diagnosis was adenoma of the adrenal gland in the majority of cases.
This study shows that LA is a safe, effective, and well-tolerated procedure. It may be recommended as a "gold standard" surgery in a case of benign functioning or non-functioning adrenal tumours with diameter less than 8 cm. (Pol J Endocrinol 2010; 61 (1): 94-101).
过去二十年，腹腔镜肾上腺切除术（LA）已成为治疗良性肾上腺病变的标准治疗方法，使开放肾上腺切除术（OA）的适应证受到限制。本研究的目的是展示一家医疗中心在开放（OA）和腹腔镜肾上腺切除术（LA）方面 30 年的经验，并比较 OA 和 LA 治疗良性肾上腺病变的结果。
1979 年至 2009 年，在波兰什切青居里夫人医院，有 300 例患者接受了 127 例开放手术和 173 例腹腔镜肾上腺切除术。分析的因素包括患者的人口统计学数据、ASA 评分、手术指征、肿瘤大小和侧别、切除肿瘤的特征、LA 和 OA 的术中及术后结果、术后疼痛感觉、术中及术后并发症以及从 LA 转为 OA 的转化率。直径超过 8cm 的肿瘤被排除在外。
两组患者的术前分析数据无显著差异。LA 组的手术时间较长（137 比 82 分钟，p<0.0001），LA 组的出血量较少（110 比 254 毫升，p<0.0001）。LA 组术后恢复正常饮食的时间较短（22 比 44 小时），下床活动时间较短（17 比 36 小时），住院时间较短（4.6 比 6.8 天），恢复正常活动时间较短（14 比 23 天，p<0.0001）。LA 组术后第 1 天和第 2 天的镇痛需求较低（p<0.0001）。两组术中及术后并发症的发生率无显著差异。LA 转为 OA 的比例为 16%。组织病理学诊断大多数病例为肾上腺腺瘤。
本研究表明，LA 是一种安全、有效、耐受良好的方法。对于直径小于 8cm 的良性功能性或非功能性肾上腺肿瘤，LA 可作为“金标准”手术推荐。（波兰内分泌杂志 2010；61（1）：94-101）。
