Economopoulos Konstantinos P, Phitayakorn Roy, Lubitz Carrie C, Sadow Peter M, Parangi Sareh, Stephen Antonia E, Hodin Richard A
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Surgery. 2016 Jan;159(1):240-8. doi: 10.1016/j.surg.2015.07.045. Epub 2015 Oct 9.
Although laparoscopic transperitoneal adrenalectomy (LTA) has become a standard operative approach to patients with benign adrenal masses, some authors have suggested that LTA should be avoided in obese patients, patients who have had previous abdominal surgery, and in cases of bilateral adrenalectomy. We sought to determine whether LTA in these clinical situations is associated with worse outcomes.
Consecutive patients who underwent LTA at a tertiary care center (1/2002-8/2014) were reviewed retrospectively. Study endpoints included operative time, duration of stay, conversion to open procedure, and postoperative complications. Statistical analyses were performed by use of Wilcoxon rank sum test, Kruskal-Wallis test, Fisher exact test, χ(2) test, and binary logistic regression analyses.
A total of 365 patients had a planned LTA, 6 of whom were converted to an open adrenalectomy. Obesity, history of previous abdominal surgery, and bilateral adrenalectomy were not associated with greater conversion rates or postoperative complications. Male sex, tumor size ≥ 4 cm and obesity (body mass index ≥ 30 kg/m(2)) were significant factors associated with increased operative time. Bilateral adrenalectomy, age, and pheochromocytomas were associated with increased hospital stays.
Obesity, history of prior abdominal surgery and bilateral adrenalectomy should not be used to discourage experienced adrenal surgeons from performing LTA.
尽管腹腔镜经腹肾上腺切除术（LTA）已成为治疗肾上腺良性肿块患者的标准手术方法，但一些作者认为，肥胖患者、既往有腹部手术史的患者以及双侧肾上腺切除术患者应避免行LTA。我们试图确定在这些临床情况下行LTA是否会导致更差的预后。
回顾性分析在一家三级医疗中心（2002年1月至2014年8月）接受LTA的连续患者。研究终点包括手术时间、住院时间、转为开放手术以及术后并发症。采用Wilcoxon秩和检验、Kruskal-Wallis检验、Fisher精确检验、χ²检验和二元逻辑回归分析进行统计分析。
共有365例患者计划行LTA，其中6例转为开放肾上腺切除术。肥胖、既往腹部手术史和双侧肾上腺切除术与更高的转为开放手术率或术后并发症无关。男性、肿瘤大小≥4 cm和肥胖（体重指数≥30 kg/m²）是与手术时间延长相关的显著因素。双侧肾上腺切除术、年龄和嗜铬细胞瘤与住院时间延长有关。
肥胖、既往腹部手术史和双侧肾上腺切除术不应成为阻碍有经验的肾上腺外科医生进行LTA的因素。
