Brunt L M, Doherty G M, Norton J A, Soper N J, Quasebarth M A, Moley J F
Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Am Coll Surg. 1996 Jul;183(1):1-10.
Laparoscopic adrenalectomy has recently been used for removing a variety of adrenal neoplasms. The purpose of the present study was to compare results and outcomes in patients who underwent either laparoscopic or open adrenalectomy at our institution from 1988 to the present.
The records of 66 consecutive patients with benign adrenal neoplasms who underwent adrenalectomy from 1988 through 1995 were retrospectively reviewed. Patients were divided into three groups based on the operative approach: group I (n = 25), open anterior transabdominal approach; group II (n = 17), open posterior retroperitoneal approach; and group III (n = 24), laparoscopic transabdominal flank approach. Various parameters were compared and statistical analyses were performed.
The three groups were similar in age, gender, American Society of Anesthesiologists class, and distribution of unilateral compared with bilateral adrenalectomy. Mean tumor size was slightly larger in group I (3.4 +/- 1.4 cm) than in group II (2.4 +/- 1.4 cm) or group III (2.7 +/- 1.4 cm) (p = NS). Mean operative times for unilateral adrenalectomy were 142 +/- 38 minutes in group I, 136 +/- 34 minutes in group II, and 183 +/- 35 minutes in group III (p < 0.001, groups I and II compared with group III). For bilateral adrenalectomy, mean operative times were 205 +/- 71 minutes (group I), 328 +/- 11 minutes (group II), and 422 +/- 77 minutes (group III). Patients who underwent laparoscopic adrenalectomy had significantly less operative blood loss (mean, 104 mL compared to 408 mL in group I and 366 mL in group II, p < 0.001) and a lower incidence of perioperative blood transfusion. Laparoscopic adrenalectomy was also associated with significantly reduced parenteral pain medication requirements (p < or = 0.001) and more rapid resumption of a regular diet (p < or = 0.01) compared to open adrenalectomy. Postoperative length of stay was significantly longer in group I (8.7 +/- 4.5 days) and in group II (6.2 +/- 3.9 days) after open adrenalectomy than after laparoscopic adrenalectomy (3.2 +/- 0.9 days) (p < 0.01). Total hospital charges were similar for groups II and III but somewhat higher for group I. Patients were able to resume 100 percent activity an average of 10.6 +/- 4.9 days after laparoscopic adrenalectomy and returned to work a mean of 16.0 +/- 6.1 days postoperatively.
Laparoscopic adrenalectomy is a safe and effective procedure and has several advantages over open adrenalectomy. Laparoscopic adrenalectomy should become the preferred operative approach for the treatment of patients with small, benign adrenal neoplasms.
腹腔镜肾上腺切除术近来已用于切除各种肾上腺肿瘤。本研究的目的是比较1988年至今在我院接受腹腔镜或开放性肾上腺切除术患者的结果及预后。
回顾性分析了1988年至1995年连续66例接受肾上腺切除术的良性肾上腺肿瘤患者的记录。根据手术方式将患者分为三组：第一组（n = 25），开放性经腹前入路；第二组（n = 17），开放性经后腹膜后入路；第三组（n = 24），腹腔镜经腹侧入路。比较了各项参数并进行了统计分析。
三组患者在年龄、性别、美国麻醉医师协会分级以及单侧与双侧肾上腺切除术的分布方面相似。第一组平均肿瘤大小（3.4±1.4 cm）略大于第二组（2.4±1.4 cm）或第三组（2.7±1.4 cm）（p =无显著性差异）。单侧肾上腺切除术的平均手术时间在第一组为142±38分钟，第二组为136±34分钟，第三组为183±35分钟（p < 0.001，第一组和第二组与第三组比较）。对于双侧肾上腺切除术，平均手术时间分别为205±71分钟（第一组）、328±11分钟（第二组）和422±77分钟（第三组）。接受腹腔镜肾上腺切除术的患者术中失血量明显较少（平均104 mL，而第一组为408 mL，第二组为366 mL，p < 0.001），围手术期输血发生率较低。与开放性肾上腺切除术相比，腹腔镜肾上腺切除术还与肠外止痛药物需求显著减少（p≤0.001）以及恢复正常饮食更快（p≤0.01）相关。开放性肾上腺切除术后第一组（8.7±4.5天）和第二组（6.2±3.9天）的术后住院时间明显长于腹腔镜肾上腺切除术后（3.2±0.9天）（p < 0.01）。第二组和第三组的总住院费用相似，但第一组略高。腹腔镜肾上腺切除术后患者平均10.6±4.9天能够恢复100%的活动，术后平均16.0±6.1天返回工作岗位。
腹腔镜肾上腺切除术是一种安全有效的手术方法，与开放性肾上腺切除术相比有几个优点。腹腔镜肾上腺切除术应成为治疗小的良性肾上腺肿瘤患者的首选手术方式。
