Nguyen Phuong H, Keller Jennifer E, Novitsky Yuri W, Heniford B Todd, Kercher Kent W
Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina 28204, USA.
Am Surg. 2011 May;77(5):592-6.
Laparoscopic expertise increases the volume of adrenalectomies at referral centers. We report our 10-year experience with laparoscopic adrenalectomy. All laparoscopic adrenalectomies at a single institution were prospectively recorded in a surgical outcomes database. Patient demographics, operative/perioperative outcomes, and adrenal pathology were reviewed retrospectively. From March 1999 through July 2009, 154 laparoscopic adrenalectomies were performed in 150 patients. Average patient age was 49.9 years (range 15-82); mean body mass index was 31.1 kg/m(2) (range 17-56). Pathologic diagnoses included hyperaldosteronism (n = 69), nonfunctional adenoma (n = 28), pheochromocytoma (n = 23), hypercortisolism (n = 14), malignancy (primary n = 3, metastasis n = 9), and cyst (n = 4). Seventy-three per cent (n = 110) occurred on the left, 23 per cent (n = 35) on the right, 2.6 per cent (n = 4) bilateral, and 0.6 per cent (n = 1) as extra-adrenal. The average tumor measured 3.6 cm (range 0.4-12). The average operative time was 156 minutes (range 62-409), the mean estimated blood loss was 60 mL (range 10-400), and mean American Society of Anesthesiologists score was 2.6 (range 1-4). Three operations (0.2%) were converted to open. Three patients (0.2%) experienced perioperative complications (respiratory failure, urinary tract infection, line sepsis, and readmission within 30 days). The average length of stay was 3.4 days (range 1-44) and mean follow-up was 96.9 days (5-2567). No wound-related complications or deaths occurred. Pathologic diagnosis was not associated with a particular side or development of a complication (P > 0.5). Patients with pheochromocytomas had the longest operative times, highest estimated blood loss, and highest American Society of Anesthesiologists scores (218.2 minutes, 128 mL, 3.0; P < 0.004). Laparoscopic adrenalectomy is safe and effective. Removal of pheochromocytomas is more challenging and may be more appropriate for referral to a specialized center for optimal outcomes.
腹腔镜技术水平的提高增加了转诊中心肾上腺切除术的手术量。我们报告了我们在腹腔镜肾上腺切除术方面的10年经验。一家机构的所有腹腔镜肾上腺切除术均前瞻性地记录在手术结果数据库中。对患者的人口统计学资料、手术/围手术期结果及肾上腺病理情况进行了回顾性分析。从1999年3月至2009年7月，对150例患者实施了154例腹腔镜肾上腺切除术。患者平均年龄为49.9岁（范围15 - 82岁）；平均体重指数为31.1kg/m²（范围17 - 56）。病理诊断包括醛固酮增多症（n = 69）、无功能腺瘤（n = 28）、嗜铬细胞瘤（n = 23）、皮质醇增多症（n = 14）、恶性肿瘤（原发性n = 3，转移性n = 9）及囊肿（n = 4）。73%（n = 110）发生在左侧，23%（n = 35）在右侧，2.6%（n = 4）为双侧，0.6%（n = 1）为肾上腺外。平均肿瘤大小为3.6cm（范围0.4 - 12cm）。平均手术时间为156分钟（范围62 - 409分钟），平均估计失血量为60mL（范围10 - 400mL），平均美国麻醉医师协会评分为2.6（范围1 - 4）。3例手术（0.2%）中转开腹。3例患者（0.2%）出现围手术期并发症（呼吸衰竭、尿路感染、导管败血症及30天内再次入院）。平均住院时间为3.4天（范围1 - 44天），平均随访时间为96.9天（5 - 2567天）。未发生与伤口相关的并发症或死亡。病理诊断与特定的手术侧别或并发症的发生无关（P > 0.5）。嗜铬细胞瘤患者的手术时间最长、估计失血量最多、美国麻醉医师协会评分最高（218.2分钟、128mL、3.0；P < 0.004）。腹腔镜肾上腺切除术安全有效。切除嗜铬细胞瘤更具挑战性，可能更适合转诊至专科中心以获得最佳治疗效果。
