Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China.
Department of Pathology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China.
J Invest Surg. 2021 Sep;34(9):957-962. doi: 10.1080/08941939.2020.1719243. Epub 2020 Feb 9.
The comparisons between open surgery and minimally invasive surgery for treatment of large adrenal tumor (LAT) are still lacking. In this study, we attempted to explore the safety and effectiveness of laparoscopic treatment of LAT by comparing the outcomes between open adrenalectomy (OA) and laparoscopic adrenalectomy (LA).
From 2003 to 2018, 78 LAT patients underwent tumor resection by OA or LA method at a single academic institution. Data were retrospectively collected and analyzed.
The median largest diameter of LAT was 10.0 (IQR 9.0-13.4) cm. The median operation time in OA group was 215 (IQR 180-240) min versus 180 (IQR 135-245) min in LA group ( = 0.042). The median blood loss in OA group was 1000 (IQR 625-1500) ml versus 200 (IQR 100-700) ml in LA group ( < 0.001). The median Clavien-Dindo score in OA group was 2 (IQR 2-4) versus 0 (IQR 0-4) in LA group ( = 0.035). On univariate and multivariate analysis, the largest diameter of tumor was significantly associated with operation time, blood loss, and recovery time ( < 0.05).
Laparoscopic treatment of LAT was found to be safe and feasible in experienced hands and can replace open surgeries in most cases.
目前对于大型肾上腺肿瘤（LAT）的治疗，开放手术与微创手术的比较研究仍然较少。本研究旨在通过比较开放肾上腺切除术（OA）与腹腔镜肾上腺切除术（LA）的结果，探讨腹腔镜治疗 LAT 的安全性和有效性。
本研究回顾性分析了 2003 年至 2018 年期间，在一家学术机构接受 OA 或 LA 治疗的 78 例 LAT 患者的数据。
LAT 的最大直径中位数为 10.0cm（IQR 9.0-13.4cm）。OA 组的手术时间中位数为 215min（IQR 180-240min），LA 组为 180min（IQR 135-245min）（ = 0.042）。OA 组的术中出血量中位数为 1000ml（IQR 625-1500ml），LA 组为 200ml（IQR 100-700ml）（ < 0.001）。OA 组的 Clavien-Dindo 评分中位数为 2 分（IQR 2-4 分），LA 组为 0 分（IQR 0-4 分）（ = 0.035）。单因素和多因素分析显示，肿瘤的最大直径与手术时间、出血量和恢复时间显著相关（ < 0.05）。
在经验丰富的医生手中，腹腔镜治疗 LAT 是安全可行的，并且在大多数情况下可以替代开放手术。
