Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Br J Surg. 2010 Nov;97(11):1667-72. doi: 10.1002/bjs.7191.
The aim of this study was to review an experience with retroperitoneal endoscopic adrenalectomy (REA). This is the procedure of choice for adrenal tumours at this institution.
Between 1997 and 2008, 112 REAs were performed in a single university centre. Data were retrieved retrospectively from a prospectively collected database, including information on patient demographics, surgical procedure, complications and hospital stay.
One hundred and twelve REAs were carried out successfully in 105 patients, including seven bilateral adrenalectomies. Thirty-nine patients with unilateral adrenal disease had a phaeochromocytoma, of whom 16 had multiple endocrine neoplasia syndrome type 2, 21 patients had Cushing's disease and 20 had Conn's disease. Median body mass index was 27 (interquartile range 23-29) kg/m(2). The median duration of unilateral operations was 100 (90-130) min with a median blood loss of 5 ml. Median tumour size was 3.1 (2.0-4.4) cm. Conversion from REA to open surgery was needed in two patients. Seven patients experienced postoperative complications (2 major, 5 minor). One patient needed a reoperation. The median postoperative hospital stay was 3 days. A learning curve with a significant decrease in operating time was observed over the years.
REA appears to be a safe and effective surgical technique for adrenal gland tumours up to 6 cm in diameter, with a minimal complication rate.
本研究旨在回顾经腹膜后内窥镜肾上腺切除术（REA）的经验。这是该机构治疗肾上腺肿瘤的首选方法。
1997 年至 2008 年间，在一个单一的大学中心进行了 112 例 REA。从一个前瞻性收集的数据库中回顾性检索数据，包括患者人口统计学、手术程序、并发症和住院时间信息。
105 例患者成功进行了 112 例 REA，包括 7 例双侧肾上腺切除术。39 例单侧肾上腺疾病患者患有嗜铬细胞瘤，其中 16 例患有多发性内分泌肿瘤综合征 2 型，21 例患有库欣病，20 例患有康恩氏病。中位数体重指数为 27（四分位距 23-29）kg/m2。单侧手术的中位持续时间为 100（90-130）min，中位出血量为 5ml。中位数肿瘤大小为 3.1（2.0-4.4）cm。有 2 例患者需要将 REA 转为开放手术。7 例患者发生术后并发症（2 例重大，5 例轻微）。1 例患者需要再次手术。中位术后住院时间为 3 天。随着时间的推移，观察到手术时间的显著减少，呈现出学习曲线。
REA 似乎是一种安全有效的治疗直径达 6cm 以下肾上腺肿瘤的手术技术，并发症发生率低。
