Moriya K, Sakakibara N, Hirakawa K, Morita K, Tabata T, Yamashita N, Shinojima H, Yamashita T
Department of Urology, Kushiro City General Hospital.
Nihon Hinyokika Gakkai Zasshi. 1997 Dec;88(12):1021-7. doi: 10.5980/jpnjurol1989.88.1021.
To determine the efficiency of gasless laparoscopic adrenalectomy, this procedure was compared to that with pneumoperitoneum.
Between February 1994 and December 1996, 17 gasless laparoscopic adrenalectomy were performed in 5 men and 12 women, 36 to 79 years old. Clinical diagnosis was primary aldosteronism in 8, pheocromocytoma in 2, incidentaloma in 4 and adrenal cyst in 3. When gasless laparoscopic adrenalectomy was performed, the laparoscope was inserted through the upper margin of the umbilicus by open laparotomy. To create a workable space, a 1.2 mm Kirschner wire was advanced subcutaneously below the costal arch and attached to a retractor. Operating time, estimated blood loss, changes of the end tidal CO2 concentration during operation, operative complications and postoperative course were compared to those with pneumoperitoneum in 12 cases.
In both procedures, satisfying workable spaces were created in all cases. The mean operating time and estimated blood loss were 245 min and 201 ml without pneumoperitoneum, 317 min and 274 ml with pneumoperitoneum, respectively. The mean changes of end tidal CO2 concentration during operation were 3.2 mmHg without pneumoperitoneum and 5.1 mmHg with pneumoperitoneum. As operative complications, open operations were required in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum) to control intraoperative bleeding. They had the histories of transabdominal operations. Postoperative bleeding was observed in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum). One of them (with pneumoperitoneum) needed surgical management for hemostasis. Fever over 38 degrees C that occurred in 1 case with pneumoperitoneum appeared to be absorption fever. No differences were observed in the number of the days to the start of oral intake and for postoperative hospitalization between the two groups.
Gasless laparoscopic adrenalectomy is available for most adrenal tumors. Suction could be used unrestrictedly and there were no hemodynamic or ventilatory effects due to pneumoperitoneum. This procedure appears to be safe and advantageous for the treatment of most adrenal tumors.
为确定免气腹腹腔镜肾上腺切除术的效率，将该手术与气腹腹腔镜肾上腺切除术进行比较。
1994年2月至1996年12月，对5名男性和12名女性（年龄36至79岁）实施了17例免气腹腹腔镜肾上腺切除术。临床诊断为原发性醛固酮增多症8例、嗜铬细胞瘤2例、肾上腺意外瘤4例、肾上腺囊肿3例。行免气腹腹腔镜肾上腺切除术时，通过开放剖腹术经脐上缘插入腹腔镜。为创建一个可操作空间，将一根1.2毫米的克氏针经皮下推进至肋弓下方并连接到一个牵开器上。将手术时间、估计失血量、术中呼气末二氧化碳浓度变化、手术并发症及术后病程与12例气腹腹腔镜肾上腺切除术的情况进行比较。
两种手术方式在所有病例中均创建了满意的可操作空间。免气腹组平均手术时间和估计失血量分别为245分钟和201毫升，气腹组分别为317分钟和274毫升。术中呼气末二氧化碳浓度的平均变化免气腹组为3.2毫米汞柱，气腹组为5.1毫米汞柱。作为手术并发症，2例（1例免气腹，1例气腹）需转为开放手术以控制术中出血，这2例均有经腹手术史。2例（1例免气腹，1例气腹）出现术后出血，其中1例（气腹组）需要手术止血。1例气腹患者出现体温超过38摄氏度，似乎为吸收热。两组在开始经口进食天数和术后住院天数方面未观察到差异。
免气腹腹腔镜肾上腺切除术适用于大多数肾上腺肿瘤。可无限制地使用吸引器，且不存在气腹引起的血流动力学或通气影响。该手术方式对于大多数肾上腺肿瘤的治疗似乎安全且具有优势。
