Villar del Moral Jesús María, Rodríguez González José Manuel, Moreno Llorente Pablo, Martos Martínez Juan Manuel, de la Quintana Barrasate Aitor, Expósito Rodríguez Amaia, Martínez Lesquereux Lucía, Durán Poveda Manuel
Servicio de Cirugía General, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Cir Esp. 2011 Dec;89(10):663-9. doi: 10.1016/j.ciresp.2011.07.003. Epub 2011 Sep 9.
The indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments.
Data was gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann-Whitney Test for the quantitative variables and chi squared for the qualitative ones.
Thirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%). Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volume units (more than 10 per year) used more frequently the laparoscopic approach (P=.019), and had a shorter overall hospital stay (P<.0001). Laparoscopic adrenalectomy was also associated with a shorter hospital stay (P<.0001).
Laparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay.
随着腹腔镜技术的应用以及偶发瘤检出率的不断提高，肾上腺切除术的适应证可能正在发生变化。西班牙外科医生协会内分泌外科分会开展了一项调查，以分析目前肾上腺切除术的适应证及其在西班牙外科科室的治疗结果。
收集了有关医院和科室类型、手术量、定位检查和术前准备、适应证、手术方式以及发病率和住院时间方面的结果等数据。使用曼-惠特尼检验对定量变量比较各中心的活动量结果，定性变量则采用卡方检验。
36个中心完成了调查问卷，2008年共报告实施了301例肾上腺切除术。最常见的适应证为嗜铬细胞瘤（25.2%）、无功能腺瘤（16.2%）、醛固酮瘤（15.9%）、库欣腺瘤（11.2%）、转移瘤（10.3%）、髓样脂肪瘤（5.6%）和癌（4.9%）。83.7%的病例实施了腹腔镜肾上腺切除术（6.7%需要转为开腹手术）。腹腔镜肾上腺切除术的平均住院时间为3.9天，开腹手术为7.4天。高手术量单位（每年超过10例）更频繁地采用腹腔镜手术方式（P = 0.019），且总体住院时间更短（P < 0.0001）。腹腔镜肾上腺切除术也与较短的住院时间相关（P < 0.0001）。
在西班牙，腹腔镜肾上腺切除术已成为标准术式，在发病率和住院时间方面效果良好。高手术量中心在微创手术的应用和住院时间方面有更好的结果。
