Sand J, Saaristo J, Nordback I, Auvinen O
Department of Surgery, Tampere University Hospital, Finland.
Ann Chir Gynaecol. 1997;86(3):234-7.
The laparoscopic approach has become popular for adrenal surgery.
When starting with laparoscopic adrenalectomies we studied our experiences of posterior open approach for different adrenal disorders to obtain reference data.
Between 1983 and 1993 95 adrenalectomies were performed, of which 59 were via the posterior route. There were 51 unilateral (7 phaeochromocytomas, 6 Cushing's syndromes, 33 Conn's syndromes, 1 sex steroid secreting tumour and 4 incidentalomas) and 8 (Cushing's disease) bilateral adrenalectomies.
Of the 4 incidentalomas one was a benign adenoma, one was cyst, one was cortical carcinoma, and one was a metastasis from breast cancer. Operative blood loss was median 300 ml, being higher in the bilateral than in the unilateral adrenalectomies (median 500 (range 300-1,250) ml vs. 300 (30-4,500 ml) (P = 0.01). Complications occurred in overall 11 patients (19%) (8 wound infections, 3 postoperative bleeding, 2 pneumonias, 1 urinary infection). Complications were more frequent in Cushing's patients than in the others (6/14 (43%) vs. 5/45 (11%); P = 0.015). Postoperative hospital stay was median 8 (range 5-21) days. The patients started liquids orally and were mobilised on the first post operative day, except for the 3 re-operated patients. Thromboembolic complications did not occur. Narcotics were used postoperatively for median 2 (range 0-7) days.
With the posterior approach mortality and complications related to the pancreas, spleen, colon and duodenum were avoided. Other complications were rare except for the patients with Cushing's disease or syndrome.
腹腔镜手术方法在肾上腺手术中已变得流行。
在开始进行腹腔镜肾上腺切除术时，我们研究了经后入路开放手术治疗不同肾上腺疾病的经验，以获取参考数据。
1983年至1993年间，共进行了95例肾上腺切除术，其中59例经后入路。有51例单侧手术（7例嗜铬细胞瘤、6例库欣综合征、33例原发性醛固酮增多症、1例分泌性类固醇肿瘤和4例偶发瘤）以及8例（库欣病）双侧肾上腺切除术。
4例偶发瘤中，1例为良性腺瘤，1例为囊肿，1例为皮质癌，1例为乳腺癌转移瘤。术中失血量中位数为300毫升，双侧肾上腺切除术的失血量高于单侧肾上腺切除术（中位数500（范围300 - 1250）毫升对300（30 - 4500毫升）（P = 0.01）。总体11例患者（19%）出现并发症（8例伤口感染、3例术后出血、2例肺炎、1例尿路感染）。库欣综合征患者的并发症比其他患者更常见（6/14（43%）对5/45（11%）；P = 0.015）。术后住院时间中位数为8（范围5 - 21）天。除3例再次手术患者外，患者术后第一天开始经口进食并活动。未发生血栓栓塞并发症。术后使用麻醉剂的时间中位数为2（范围0 - 7）天。
采用后入路可避免与胰腺、脾脏、结肠和十二指肠相关的死亡率和并发症。除库欣病或综合征患者外，其他并发症罕见。
