Henry J F, Denizot A, Puccini M, Kvachenyuk A, Ferrara J J
Service de Chirurgie Générale et Endocrinienne, CHU Timone, Marseille, France.
Ann Endocrinol (Paris). 1996;57(6):520-5.
Over the last four years it has been demonstrated that laparoscopy can be used successfully for adrenalectomy, providing certain advantages over conventional open surgery. The aim of this study was to determine the indications for laparoscopic approach in adrenal surgery. From June 1994 to June 1996 laparoscopic transabdominal flank approaches 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. Among 77 patients requiring ablation of the adrenal gland, 50 (65%) underwent a laparoscopic procedure: 29 Conn adenomas, 10 Cushing adenomas, 6 Pheochromocytomas, 4 incidentalomas. One patient had Cushing's disease and underwent bilateral resection. Mean tumor size was 26 mm (7-75 mm). Malignancy was demonstrated in 2 tumors: one cortisone secreting tumor and one leiomyosarcoma. Conversion was required in 4 cases (8%). Mean operative time for unilateral adrenalectomies was 147 minutes (50-300'). 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 phebitis of the lower limb. The endocrinopathy was successfully cured in all patients with secreting tumors. The 27 other patients underwent open adrenalectomy. Laparoscopic approach was not proposed due to suspected malignancy in 13 cases, previous surgery in 8 cases and multiple, bilateral and/or extra adrenal tumors in 6 cases. Laparoscopic approach to the adrenal gland is the procedure of choice in patients with Conn adenomas, Cushing adenomas and in most cases of pheochromocytomas. It is not indicated for malignant and large tumor (> 8 cm). Currently two-thirds of our patients requiring and adrenalectomy are operated laparoscopically.
在过去四年中已证实，腹腔镜检查可成功用于肾上腺切除术，与传统的开放手术相比具有某些优势。本研究的目的是确定肾上腺手术中腹腔镜手术的适应证。1994年6月至1996年6月，对于肾上腺单侧肿瘤直径8厘米及以下的非恶性肿瘤患者，采用腹腔镜经腹侧腰部入路。对于直径小于4厘米的肿瘤，仅切除分泌性肿瘤。在77例需要切除肾上腺的患者中，50例（65%）接受了腹腔镜手术：29例Conn腺瘤、10例库欣腺瘤、6例嗜铬细胞瘤、4例偶发瘤。1例患者患有库欣病，接受了双侧切除术。肿瘤平均大小为26毫米（7 - 75毫米）。2例肿瘤证实为恶性：1例分泌可的松肿瘤和1例平滑肌肉瘤。4例（8%）需要中转开腹。单侧肾上腺切除术的平均手术时间为147分钟（50 - 300分钟）。无死亡病例。并发症包括：1例经套管针穿刺孔出血需再次手术，1例脾梗死自行消退，1例腹壁血肿，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。其他27例患者接受了开放性肾上腺切除术。13例因怀疑恶性、8例因既往手术、6例因多发、双侧和/或肾上腺外肿瘤而未采用腹腔镜手术。对于Conn腺瘤、库欣腺瘤患者以及大多数嗜铬细胞瘤患者，腹腔镜肾上腺手术是首选方法。对于恶性和大肿瘤（> 8厘米）不适用。目前，我们需要进行肾上腺切除术的患者中有三分之二接受腹腔镜手术。
