Venkatasubramanian R, Wadhwa Atul, Sharma Anil, Khullar Rajesh, Soni Vandana, Baijal Manish, Chowbey P K
Consultant Surgeon Minimal Access and Bariatric Surgery Center, Sir Ganga Ram Hospital, Room No. 200 (IInd floor), New Delhi, 110 060 India.
Indian J Surg. 2007 Aug;69(4):129-35. doi: 10.1007/s12262-007-0003-7. Epub 2008 Jul 30.
To analyze patient demographics, pathology, surgical procedure and outcome in initial 24 consecutive patients who underwent laparoscopic adrenalectomy in our department.
Twenty four patients underwent laparoscopic adrenalectomy between September 2000 and August 2005. There were 12 males and 12 females with a mean age of 44.6 years (range 25-68 years). The indications for adrenalectomy were pheochromocytoma (13 patients), Cushing's syndrome (5 patients), myelolipoma (2 patients), adrenal cyst (2 patients), aldosteronoma (1 patient) and adrenal incidentaloma (1 patient). Nineteen of our patients with functioning adrenal tumours were prepared preoperatively for periods ranging up to 2 weeks by the endocrinologist. All laparoscopic adrenalectomies were performed via lateral transperitoneal approach using standard four-port technique. Patients with pheochromocytoma and Cushing's syndrome were monitored in the surgical intensive care unit during immediate postoperative period. The clinical and intraoperative characteristics, complications and outcomes of all patients were analyzed.
The mean operative time for laparoscopic adrenalectomy was 136 minutes. Intraoperative hypertension occurred in 8 patients. Intraoperative hypotension occurred in 2 patients. One patient required conversion due to dense adhesions and hemorrhage. Postoperative complications were seen in six patients - immediate postoperative hypotension (2 patients), features of steroid withdrawal (2 patients) and postoperative pyrexia (2 patients). Five patients with pheochromocytoma required antihypertensive drugs in the postoperative period. There was no mortality in our series.
Laparoscopic adrenalectomy is a safe operation that incorporates all the benefits of minimal access surgery and is associated with a satisfactory postoperative outcome. A careful preoperative preparation in functioning adrenal tumours aids in the faster recovery of these patients.
分析我院最初连续接受腹腔镜肾上腺切除术的24例患者的人口统计学特征、病理、手术过程及结果。
2000年9月至2005年8月期间，24例患者接受了腹腔镜肾上腺切除术。其中男性12例，女性12例，平均年龄44.6岁（范围25 - 68岁）。肾上腺切除术的适应证包括嗜铬细胞瘤（13例）、库欣综合征（5例）、肾上腺髓质脂肪瘤（2例）、肾上腺囊肿（2例）、醛固酮瘤（1例）和肾上腺偶发瘤（1例）。19例功能性肾上腺肿瘤患者术前由内分泌科医生进行了长达2周的准备。所有腹腔镜肾上腺切除术均采用标准四孔技术经侧方经腹途径进行。嗜铬细胞瘤和库欣综合征患者术后即刻在外科重症监护病房进行监测。分析了所有患者的临床和术中特征、并发症及结果。
腹腔镜肾上腺切除术的平均手术时间为136分钟。8例患者术中出现高血压。2例患者术中出现低血压。1例患者因粘连致密和出血需要中转开腹。6例患者出现术后并发症——术后即刻低血压（2例）、类固醇戒断症状（2例）和术后发热（2例）。5例嗜铬细胞瘤患者术后需要使用降压药物。本系列无死亡病例。
腹腔镜肾上腺切除术是一种安全的手术，兼具微创手术的所有优点，术后效果良好。对功能性肾上腺肿瘤进行仔细的术前准备有助于这些患者更快康复。
