Hirano Daisaku, Hasegawa Ryo, Igarashi Tomohiro, Satoh Katsuhiko, Mochida Junichi, Takahashi Satoru, Yoshida Toshio, Saitoh Tadanori, Kiyotaki Shuji, Okada Kiyoki
Department of Urology, Higashimatsuyama City Municipal Hospital, Saitama, Japan.
Department of Urology, Higashimatsuyama City Municipal Hospital, Saitama, Japan.
Asian J Surg. 2015 Apr;38(2):79-84. doi: 10.1016/j.asjsur.2014.09.003. Epub 2014 Nov 3.
We have performed laparoscopic adrenalectomy including retroperitoneoscopic adrenalectomy via a single large port (RASLP) and conventional laparoscopic adrenalectomy (CLA) for adrenal tumors since 1992, and report our experience to date.
The study population consisted of 134 patients who underwent laparoscopic adrenalectomy from 1992 to 2012. Fifty-eight patients (18 aldosterone-producing adenomas, 13 adenomas with Cushing's syndrome, 1 adenoma with preclinical Cushing's syndrome, and 26 nonfunctioning tumors) were treated using RASLP, and 76 patients (33 aldosterone-producing adenomas, 17 adenomas with Cushing's syndrome, 6 adenomas with preclinical Cushing's syndrome, 17 pheochromocytomas, and 3 nonfunctioning tumors) were treated using CLA. Complications were graded according to the modified Clavien system.
The majority of RASLPs were performed during the 1990s, whereas all patients underwent CLA after 2000. The mean operation times (166 vs. 205 minutes, p < 0.01) and intraoperative estimated blood loss (85 vs. 247 mL, p < 0.01) were significantly lower in the CLA group. Conversion to open surgery was required in three patients (5%) in the RASLP group and five patients (7%) in the CLA group (p = 0.73). Postoperative complications were grade 1 in three patients and grades 4 and 5 in one patient each in the RASLP group, whereas grade 2 in one patient was observed in the CLA group (p = 0.085).
Although this study included biases such as different eras and indications, CLA resulted in decreased operative times, blood loss, and postoperative complications compared with RASLP. CLA has so far become our preferred procedure for patients with adrenal tumor in our experience.
自1992年以来，我们开展了腹腔镜肾上腺切除术，包括经单一大端口后腹腔镜肾上腺切除术（RASLP）和传统腹腔镜肾上腺切除术（CLA）治疗肾上腺肿瘤，并报告我们至今的经验。
研究对象为1992年至2012年接受腹腔镜肾上腺切除术的134例患者。58例患者（18例醛固酮瘤、13例库欣综合征腺瘤、1例亚临床库欣综合征腺瘤和26例无功能肿瘤）接受RASLP治疗，76例患者（33例醛固酮瘤、17例库欣综合征腺瘤、6例亚临床库欣综合征腺瘤、17例嗜铬细胞瘤和3例无功能肿瘤）接受CLA治疗。并发症根据改良Clavien系统分级。
大多数RASLP手术在20世纪90年代进行，而所有患者在2000年后接受CLA手术。CLA组的平均手术时间（166对205分钟，p<0.01）和术中估计失血量（85对247mL，p<0.01）显著更低。RASLP组有3例患者（5%）和CLA组有5例患者（7%）需要转为开放手术（p=0.73）。RASLP组有3例患者术后并发症为1级，各有1例患者为4级和5级，而CLA组有1例患者为2级（p=0.085）。
尽管本研究存在不同时代和适应证等偏倚，但与RASLP相比，CLA导致手术时间、失血量和术后并发症减少。根据我们的经验，CLA迄今已成为我们治疗肾上腺肿瘤患者的首选术式。
