Guazzoni G, Montorsi F, Bocciardi A, Da Pozzo L, Rigatti P, Lanzi R, Pontiroli A
Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy.
J Urol. 1995 May;153(5):1597-600.
In our retrospective study we compare the effectiveness and safety of transperitoneal laparoscopic versus open adrenalectomy in 40 patients with benign hyperfunctioning unilateral adrenal tumors. Patients 1 to 20 underwent open adrenalectomy between July 1988 and July 1992, and patients 21 to 40 underwent the laparoscopic procedure between September 1992 and January 1994. Student's t test for unpaired data was used to compare intraoperative and postoperative results, and morbidity observed in the 2 groups. The affected adrenal gland was successfully removed in all cases. Mean operative time was significantly longer for laparoscopy, although it shortened progressively due to the learning curve effect. Blood loss was significantly less with laparoscopy, while only 3 patients undergoing open surgery required blood transfusions. Overall invasiveness and analgesic requirement were significantly lower with laparoscopy. The intervals to oral intake and ambulation, hospital stay and return to preoperative normal activity were shorter with laparoscopy. Major complications were noted only in open surgery patients. At 3 months all patients in both groups were cured of the underlying adrenal disease. We conclude that transperitoneal laparoscopic adrenalectomy is equally effective and less invasive than open surgery, and that it should be considered the first choice therapy for benign hyperfunctioning adrenal tumors.
在我们的回顾性研究中，我们比较了40例单侧肾上腺良性功能亢进肿瘤患者经腹腹腔镜肾上腺切除术与开放性肾上腺切除术的有效性和安全性。1至20号患者在1988年7月至1992年7月期间接受了开放性肾上腺切除术，21至40号患者在1992年9月至1994年1月期间接受了腹腔镜手术。采用成组设计资料的t检验来比较两组的术中及术后结果以及所观察到的发病率。所有病例均成功切除患侧肾上腺。腹腔镜手术的平均手术时间明显更长，不过由于学习曲线效应，其手术时间逐渐缩短。腹腔镜手术的失血量明显更少，而接受开放性手术的患者中只有3例需要输血。腹腔镜手术的总体侵袭性和镇痛需求明显更低。腹腔镜手术患者的进食和下床活动时间、住院时间以及恢复至术前正常活动的时间更短。主要并发症仅见于开放性手术患者。在3个月时，两组所有患者的潜在肾上腺疾病均得到治愈。我们得出结论，经腹腹腔镜肾上腺切除术与开放性手术同样有效且侵袭性更小，应被视为良性功能亢进肾上腺肿瘤的首选治疗方法。
