A Comparative Study Of The Three Different Procedures Of Adrenalectomy

Objective:To research the clinical application of three different procedures (posterior laparoscopic Adrenalectomy, transperitoneal laparoscopic Adrenalectomy, open Adrenalectomy) of Adrenalectomy。Method:The collected 116 cases of adrenalectomy from January 2007 to November 2009 in Shandong Provincial Hospital were analyzed, The 32 cases of retroperitoneal laparoscopic adrenalectomy,the 42 cases of transperitonal laparoscopic and the 42 cases of open adrenalectomy were classified Group A,Group B and Group C.The differences in operation time, blood-transfusion, the postoperative drainage volume, the ICU length stay after operation, and recovery time of GI function, hospitalization stay after operation, the histopathologic features,these date of the three procedures were compared with statistical analysis.Result:All the 116 cases of Adrenalectomy were successful.The mean operating time:group A was 127.5±41.8 min; group B was 117.9±54.9 min;group C was 87.4±35.3 min; the hospitalization stay after operation:group A was 6.5±3.3 d; group B was 7.8±4.2 d; group C was 9.4±2.8 d; the blood-transfusion:group A was none; group B was 3;group C was 13; the mean revovery time of G1 function: group A was 2.4±1.0 d; group B was 2.5±1.3 d;group C was 3.4±1.1 d;the mean postoperative drainage volume:group A was 91.0±83.1 ml; group B was 206.5±147.3 ml;group C was 90.9±57.6 ml;the size of tumor (CT):group A was 1.9±0.9cm; group B was 2.2±1.0cm; group C was 4.7±2.3cm; the size of tumor (US): 2.1±0.9cm; group B was 2.7±2.0cm; group C wsa 5.1±2.9cm; the histopathologic features:All the cease in group A and group were benign tumour; 5 cases of group C were malignant tumor; there were no obvious complication happened in all the cases.Conclusions:In adrenalcetomy, the slection of operation menthods should be according to the tumor size, pathological character and positon. For patients with larger tumors (>6cm) or malignant tumor diagnosised before operations。open operation was a good choose.The other patients with benign tumour and small tumors size (<6cm), the laparoscopic adrenalectomy should be performed. Laparoscopic adrenalectomy have advantages in hospitalization stay after operation, recovery time of GI function, the less blood-transfusion and the mean postoperative drainage volume than open operation (P<0.05). Retroperitoneal laparoscopic adrenalectomy is safe, effective procedure and contains all the advantages of minimally invasive surgery, less traumatic, less hospitalization stay after operation,less blood-transfusion and quicker recovery time. It should be considered as the first choice of therapy for most adrenal disorders, especially for small adrenal benign tumor (<6cm).