副腎腫瘍に対する腹腔鏡手術と開放手術の比較検討

Abstract

腹腔鏡下副腎摘除術を施行した副腎腫瘍患者25名(女17例・男8例, 22～72歳)を対象に手術成績を, 従来の開放手術例24例と比較検討した.腹腔鏡手術で開腹術へ移行した症例は2例でいずれも初期の症例であった.手術時間は腹腔鏡手術で, 平均228.8±65.5分, 開放手術で平均156.0±43.分と開放手術で有意に短時間であったが, 出血量は腹腔鏡手術で平均82.3±125.4mlと開放手術の平均210.8±167.7mlに比べ有意に少なかった.腹腔鏡手術における術後合併症は2例の開腹手術移行例以外, 500ml以上の出血, 他臓器損傷など重篤なものは認めなかった.開放手術では11例にに高頻度に認めたが, 術中加圧呼吸下に胸膜を修復し, ドレーンは不要であった.腹腔鏡手術完遂例における術後歩行開始日, 経口摂取開始日は開放手術に比べ有意に短く, 回復が早かった

We performed 25 laparoscopic adrenalectomies for adrenal tumor between January 1998 and December 2000. In 23 cases, adrenal tumors were successfully removed laparoscopically, but in 2, the laparoscopic procedure was converted to open surgery because of liver injury and endoscopically uncontrolled bleeding at the renal hilum. Postoperative complications, involving retroperitoneal hematoma, hypercapnia, and wound infections, could be managed without surgical treatment. We compared laparoscopic adrenalectomy with conventional open surgery, which had been performed for 24 adrenal tumors in our clinic. The mean operative time for the laparoscopic adrenalectomy (228.8 +/- 65.5 minutes) was significantly longer than those for the open surgery (156.0 +/- 43.8 minutes). The estimated blood loss (82.3 +/- 125.4 g) was significantly less than those for the open surgery (210.8 +/- 167.7 g), and the laparoscopic adrenalectomy had significant advantages in lessening postoperative analgesic requirements, shortening postoperative recovery period, and preserving good physical appearance. Therefore, we conclude that the laparoscopic adrenalectomy is a less invasive surgery, and is acceptable as a standard operation for adrenal tumors.