Department of Surgery, University of Pisa, Pisa, Italy.
World J Surg. 2011 Dec;35(12):2698-702. doi: 10.1007/s00268-011-1294-1.
Two main approaches have been described for endoscopic adrenalectomy: the transperitoneal approach with the patient in the lateral decubitus position (LA) and the retroperitoneal approach with the patient in the prone position (ERA). The goal of the present study was to compare the results of LA and ERA for endoscopic bilateral synchronous adrenalectomy.
Between 1994 and 2008, 34 patients underwent bilateral synchronous adrenalectomy in two referral centers: 20 patients underwent LA in Pisa (group A), and 14 patients underwent ERA in Halle (group B). Sex, age, preoperative diagnosis, body mass index, preoperative medical treatments, diameter of glands, blood loss, operative time, complications, conversion, intensive care unit stay, day of first oral intake, length of postoperative recovery, histology report, and outcome were analyzed.
There were 7 men and 13 women in group A and 6 men and 8 women in group B. Mean age was 48.1 years in group A and 38.9 years in group B. Body mass index was similar in the two groups. Diameters of the glands were larger in group A than in group B, at 61.1 versus 42.8 mm for the right side and 64.1 versus 37.4 mm for the left side. Mean hospital stay was longer in group B (8.2 versus 5.25 days; P = 0.002), whereas the intensive care unit stay was longer in group A (1.44 versus 1 day).
It is not possible to determine which of the two approaches is better; both are feasible, safe, and effective and patient outcomes are almost the same.
内镜肾上腺切除术有两种主要方法：患者侧卧位的经腹腔途径（LA）和患者俯卧位的后腹腔途径（ERA）。本研究的目的是比较 LA 和 ERA 在内镜双侧同步肾上腺切除术的结果。
1994 年至 2008 年间，有 34 例患者在两个转诊中心接受了双侧同步肾上腺切除术：20 例患者在比萨接受 LA（A 组），14 例患者在哈雷接受 ERA（B 组）。分析了性别、年龄、术前诊断、体重指数、术前药物治疗、腺体直径、出血量、手术时间、并发症、转换、重症监护病房停留时间、首次口服时间、术后恢复时间、组织学报告和结果。
A 组有 7 名男性和 13 名女性，B 组有 6 名男性和 8 名女性。A 组平均年龄为 48.1 岁，B 组为 38.9 岁。两组体重指数相似。A 组右侧腺体直径大于 B 组，为 61.1 毫米对 42.8 毫米，左侧腺体直径为 64.1 毫米对 37.4 毫米。B 组平均住院时间较长（8.2 天对 5.25 天；P=0.002），A 组重症监护病房停留时间较长（1.44 天对 1 天）。
无法确定哪种方法更好；两种方法都是可行、安全且有效的，患者的结果几乎相同。
