Piatek S, Manger T, Kunz D, Pross M, Schmidt S C, Fahlke J, Luley C, Lippert H
Klinik für Chirurgie, Otto-Von-Guericke-Universität Magdeburg.
Zentralbl Chir. 1997;122(12):1103-7.
Laparoscopic transperitoneal and endoscopic extraperitoneal adrenalectomy are two safe options in minimally invasive surgery associated with very low morbidity. The anterior transperitoneal approach we prefer yields a better exposure of the anatomic structures and allows the surgeon to orient himself more easily. In addition, various other laparoscopic maneuvers may be performed synchronously. We report on our own experience with eight laparoscopic transperitoneal adrenalectomies performed in four cases unilaterally and in two additional cases bilaterally during April, 1996, and January, 1997, in six patients aged 20 to 56 years. The indications were in four cases pheochromocytoma (operated on bilaterally in two cases), and in the remaining two cases adrenal Cushing's syndrome. The duration of surgery was approximately 240 min for bilateral adrenalectomy and 166 min for unilateral adrenalectomy, respectively, with an intraoperative blood loss of about 50 to 400 ml. Except for haematoma of the abdominal wall there were no other postoperative complications. The serum levels of interleukin 6 and 10 underline the minimal invasiveness of this technique, since there were only small increases of interleukin 6 and interleukin 10.
腹腔镜经腹腔肾上腺切除术和内镜腹膜外肾上腺切除术是微创手术中两种安全的选择，发病率极低。我们更倾向的经腹腔前路能更好地暴露解剖结构，使外科医生更容易定位。此外，还可同步进行各种其他腹腔镜操作。我们报告了我们自己的经验，1996年4月至1997年1月期间，对6例年龄在20至56岁的患者进行了8例腹腔镜经腹腔肾上腺切除术，其中4例为单侧，另外2例为双侧。适应证为4例嗜铬细胞瘤（2例双侧手术），其余2例为肾上腺库欣综合征。双侧肾上腺切除术的手术时间约为240分钟，单侧肾上腺切除术为166分钟，术中失血约50至400毫升。除腹壁血肿外，无其他术后并发症。白细胞介素6和10的血清水平表明了该技术的微创性，因为白细胞介素6和白细胞介素10仅有小幅升高。
