秋田大学における鏡視下副腎摘出症例の検討

Abstract

鏡視下副腎摘出術について, 副腎腫瘍52例を対象に検討した.51例で手術は完遂され, 1例は気腹装置不調による出血量が増加により開放手術に移行した.輸血は上記1例と術後の後腹膜出血1例に行われた.次に, 開放性副腎摘出手術30例と鏡視下手術と比較すると, 平均手術時間に有意差は認めなかったが, 平均出血量では鏡視下例が有意に少なかった.また, 術後回復では, 平均経口摂取開始, 平均歩行開始ともに, 鏡視下症例で有意に早かった.鏡視下手術の手術時間は術者が手術経験を重ねるとともに, 明らかに短縮された.また, 経験を積んだ術者の指導のもと, 新たな執刀医でも安全に, 短い手術時間で手術が施行された

We performed 52 laparoscopic adrenalectomies between January 1997 and March 2003. In 51 patients, adrenal tumors were successfully removed laparoscopically. In one patient, the laparoscopic procedure was converted to open surgery because of insufflator's trouble and hemorrhage. Perioperative blood transfusion was required in two patients; one for intraoperative and another for postoperative bleeding. We compared laparoscopic adrenalectomy with conventional open surgery which had been performed in our clinic before the laparoscopic adrenalectomy era. The mean operative time of the laparoscopic adrenalectomy (187 +/- 59 min) was not significantly longer than that of the open surgery (193 +/- 49 min). The mean estimated blood loss of laparoscopic adrenalectomy (75 +/- 145 g) was significantly less than that of the open surgery (438 +/- 447 g). Time to oral intake and ambulation for laparoscopic adrenalectomy were significantly earlier than those of the open surgery. Operation time was significantly shortened as the experience of this surgery was accumulated. The results of our experience support the concept that laparoscopic adrenalectomy is safe and is a standard treatment for surgical treatment of adrenal tumors.