加拿大中心的俯卧位后腹腔镜肾上腺切除术经验。
A Canadian centre's experience with prone retroperitoneoscopic adrenalectomy.
机构信息
From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Garber); the Department of Surgery, Powell River Hospital, Powell River, BC (Garber); the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Melck); the Department of Surgery, St. Paul's Hospital, Vancouver, BC (Melck); and the University of British Columbia, Vancouver, BC (Merali)
From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Garber); the Department of Surgery, Powell River Hospital, Powell River, BC (Garber); the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (Melck); the Department of Surgery, St. Paul's Hospital, Vancouver, BC (Melck); and the University of British Columbia, Vancouver, BC (Merali).
出版信息
Can J Surg. 2022 Oct 25;65(5):E727-E732. doi: 10.1503/cjs.013720. Print 2022 Sep-Oct.
BACKGROUND
Minimally invasive adrenalectomy is the standard of care for the surgical management of benign adrenal disease. The transperitoneal laparoscopic approach (TLA) is the most common approach used worldwide; however, many centres have adopted a posterior retroperitoneoscopic approach (PRA), as it is reported to offer several advantages. We describe our experience with PRA.
METHODS
We performed a retrospective review of the charts of patients who underwent minimally invasive adrenalectomy via PRA or TLA performed by a single endocrine surgeon between September 2010 and December 2019 at a tertiary academic centre in British Columbia, Canada. Patient and tumour characteristics, operative times and postoperative outcomes were compared between the 2 groups.
RESULTS
During the study period, 58 patients underwent adrenalectomy via PRA, and 41 underwent adrenalectomy via TLA. The median American Society of Anesthesiologists score was higher in the TLA group than the PRA group (3.0 v. 2.6, = 0.02). Adrenal glands were heavier in the TLA group than the PRA group (mean 63.4 g v. 19.2 g, < 0.001). The mean anesthesia preparation time was shorter with PRA than with TLA (51.5 min v. 63.7 min, < 0.001), as was mean operative time (77.9 min v. 118.4 min, < 0.001) and mean hospital length of stay (2 d v. 4 d, < 0.001). There was no difference in the complication rate between the 2 groups.
CONCLUSION
Our study shows that PRA offers shorter operative time and length of stay for appropriately selected patients. Thus, it has become the preferred approach at our centre for minimally invasive adrenalectomy.
背景
微创肾上腺切除术是治疗良性肾上腺疾病的标准治疗方法。经腹腔腹腔镜手术（TLA）是全球最常用的方法；然而，许多中心已经采用了后腹膜后腹腔镜手术（PRA），因为它被报道具有许多优势。我们描述了我们在这方面的经验。
方法
我们对 2010 年 9 月至 2019 年 12 月期间在加拿大不列颠哥伦比亚省的一家三级学术中心由同一位内分泌外科医生通过 PRA 或 TLA 进行微创肾上腺切除术的患者的图表进行了回顾性分析。比较了两组患者的特征、手术时间和术后结果。
结果
在研究期间，58 例患者通过 PRA 行肾上腺切除术，41 例患者通过 TLA 行肾上腺切除术。TLA 组的美国麻醉医师协会评分中位数高于 PRA 组（3.0 比 2.6， = 0.02）。TLA 组的肾上腺重量高于 PRA 组（平均 63.4 克比 19.2 克， < 0.001）。与 TLA 相比，PRA 的麻醉准备时间更短（51.5 分钟比 63.7 分钟， < 0.001），手术时间更短（77.9 分钟比 118.4 分钟， < 0.001），住院时间更短（2 天比 4 天， < 0.001）。两组的并发症发生率无差异。
结论
我们的研究表明，对于适当选择的患者，PRA 提供了更短的手术时间和住院时间。因此，它已成为我们中心微创肾上腺切除术的首选方法。
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