Aldrighetti L, Giacomelli M, Calori G, Paganelli M, Ferla G
Department of Surgery, San Raffaele Hospital, University of Milan, Italy.
Int Surg. 1997 Apr-Jun;82(2):160-4.
To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors.
Twenty patients with silent adrenal tumor underwent adrenalectomy or tumor excision through the laparotomic (LPT Group: 12 cases) or laparoscopic (LPS Group: 8 cases) approach. LPT Group and LPS Group were comparatively analyzed in terms of age, gender, Body Mass Index (BMI), concomitant diseases, previous upper abdominal surgery, tumor side and size, type of operation (excision vs adrenalectomy), associated procedures, and pathology. The two groups were then compared for intra/postoperative complications, length of operation, and postoperative ileus, pain, hospitalization. Comparisons were performed also adjusting for variables (BMI, depression, tumor size) unhomogeneously distributed between the two groups.
LPT Group and LPS Group were comparable when evaluated for age, gender, BMI, concomitant diseases (except for depression), previous upper abdominal surgery, tumor side, type of operation, associated procedures, and pathology. Tumor size (LPKT > LPS, p = 0.03) and depression (LPT < LPS, p = 0.04) turned out to be differently distribution between the two groups, and were then considered, as well as the BMI (p = 0.08), in the covariance analysis. Postoperative ileus (LPT vs LPS: 3.5 +/- 0.2 days vs 2.3 +/- 0.2 days, p = 0.006), pain (LPT vs LPS: 3.0 +/- 0.3 days vs 1.7 +/- 0.2 days, p = 0.012), and hospitalization (LPT vs LPS: 7.9 +/- 1.0 days vs 3.5 +/- 0.4 days, p = 0.0002) were statistically shorter in the LPS Group; the length of operation, even if shorter in the LPS Group (LPT vs LPS: 2.9 +/- 0.3 hours vs 2.5 +/- 0.3 hours), did not reach statistical significance (p = 0.12). Results were confirmed by covariance analysis.
Laparoscopy seems a safe and effective approach which permits adrenal surgery with lower surgical stress than laparotomic technique.
比较腹腔镜和开腹手术切除意外肾上腺肿瘤的技术。
20例无症状肾上腺肿瘤患者通过开腹手术（开腹手术组：12例）或腹腔镜手术（腹腔镜手术组：8例）进行肾上腺切除术或肿瘤切除术。对开腹手术组和腹腔镜手术组在年龄、性别、体重指数（BMI）、伴随疾病、既往上腹部手术史、肿瘤部位和大小、手术类型（切除与肾上腺切除术）、相关手术以及病理方面进行比较分析。然后比较两组的术中/术后并发症、手术时间、术后肠梗阻、疼痛及住院情况。还对两组间分布不均一的变量（BMI、抑郁、肿瘤大小）进行校正后进行比较。
在年龄、性别、BMI、伴随疾病（抑郁除外）、既往上腹部手术史、肿瘤部位、手术类型、相关手术以及病理方面评估时，开腹手术组和腹腔镜手术组具有可比性。肿瘤大小（开腹手术组＞腹腔镜手术组，p = 0.03）和抑郁（开腹手术组＜腹腔镜手术组，p = 0.04）在两组间分布不同，因此在协方差分析中与BMI（p = 0.08）一同被考虑。腹腔镜手术组术后肠梗阻（开腹手术组与腹腔镜手术组：3.5±0.2天 vs 2.3±0.2天，p = 0.006）、疼痛（开腹手术组与腹腔镜手术组：3.0±0.3天 vs 1.7±0.2天，p = 0.012）及住院时间（开腹手术组与腹腔镜手术组：7.9±1.0天 vs 3.5±0.4天，p = 0.0002）在统计学上明显更短；手术时间虽在腹腔镜手术组更短（开腹手术组与腹腔镜手术组：2.9±0.3小时 vs 2.5±0.3小时），但未达到统计学意义（p = 0.12）。协方差分析证实了结果。
腹腔镜手术似乎是一种安全有效的方法，与开腹手术技术相比，它能使肾上腺手术的手术应激更低。
