Henry J F, Denizot A, Puccini M, Ayari R
Service de Chirurgie Générale et Endocrinienne, C.H.U. Timone, Marseille.
J Chir (Paris). 1996 May;133(3):111-6.
It has been recently demonstrated that resection of the adrenal glands can be performed laparoscopically, providing certain advantages over conventional open surgery. The aim of this work was to determine the role of laparoscopy in the surgical approach to the adrenal glands. From June 1994 to December 1995, transperitoneal laparoscopic procedures were proposed in patients with a unilateral 8 cm or less non-malignant tumors of the adrenal gland. For tumors under 4 cm in diameter, only secreting tumors were removed. One patient had Cushing's disease and underwent bilateral resection. Among 58 patients requiring ablation of the adrenal gland; 37 (64%) underwent a laparoscopic procedure: 20 Conn adenomas, 8 Cushing adenomas, 1 Cushing's disease, 5 pheochromocytomas, 3 incidentalomas. Mean tumor size was 26 mm (7-75 mm). Two tumors were found to be malignant: one cortisone-secreting tumor and one leiomyosarcoma. Conversion was required in 4 cases (11%) due to difficulties in exposing the dissection in 3 cases and due to malignancy in 1. Mean operative time for unilateral operations was 159 minutes (75-300 minutes). There were no deaths. Morbidity included one hemorrhage via the trocar orifice requiring reoperation, one infarction of the spleen which regressed spontaneously, one parietal hematoma, and one case of phlebitis of the lower limb. The endocrinopathy was successfully cured in all patients with secreting tumors. The 21 other patients underwent open surgery. Laparoscopic access was contraindicated due to suspected malignancy in 10 cases, past surgical history in 7 and bilateral or extra-adrenal lesions in 4. Laparoscopic resection of the adrenal glands is the preferred technique in patients with Conn adenomas, Cushing adenomas and in most cases of pheochromocytoma. It is not indicated for malignant and/or very large tumor (> 8 cm). In our experience, the laparoscopic approach has replaced open posterior approach which is now only used exceptionally. Currently two-thirds of our patients with an indication for resection of the adrenal glands are operated laparoscopically.
最近的研究表明，肾上腺切除术可通过腹腔镜进行，与传统的开放手术相比具有一定优势。本研究的目的是确定腹腔镜在肾上腺手术中的作用。1994年6月至1995年12月，对单侧肾上腺非恶性肿瘤直径8cm及以下的患者采用经腹腹腔镜手术。对于直径小于4cm的肿瘤，仅切除分泌性肿瘤。1例库欣病患者接受了双侧切除术。在58例需要切除肾上腺的患者中，37例（64%）接受了腹腔镜手术：20例Conn腺瘤、8例库欣腺瘤、1例库欣病、5例嗜铬细胞瘤、3例偶发瘤。肿瘤平均大小为26mm（7 - 75mm）。发现2例肿瘤为恶性：1例分泌可的松肿瘤和1例平滑肌肉瘤。4例（11%）因3例暴露解剖困难和1例因恶性肿瘤而需要中转开腹。单侧手术的平均手术时间为159分钟（75 - 300分钟）。无死亡病例。并发症包括1例经套管针孔出血需再次手术、1例脾脏梗死自发消退、1例腹壁血肿和1例下肢静脉炎。所有分泌性肿瘤患者的内分泌病均成功治愈。另外21例患者接受了开放手术。10例因怀疑恶性肿瘤、7例因既往手术史、4例因双侧或肾上腺外病变而禁忌腹腔镜手术。腹腔镜肾上腺切除术是Conn腺瘤、库欣腺瘤以及大多数嗜铬细胞瘤患者的首选技术。对于恶性和/或非常大的肿瘤（>8cm）不适用。根据我们的经验，腹腔镜手术方法已取代了开放后入路，现在仅在特殊情况下使用。目前，我们有肾上腺切除指征的患者中有三分之二接受腹腔镜手术。
