복강경 부신절제술 초기 20예의 임상적 고찰
A Clinical Review of 20 Initial Cases of Laparoscopic Adrenalectomy
박훤겸, 정파종, 남영수, 백홍규, 이홍기, 이흥우, 조석주, 김상우, 이광수,
소속 상세정보
박훤겸 ( Park Hwon-Kyum )
한양대학교 의과대학 외과학교실
정파종 ( Jung Pa-Jong )
한양대학교 의과대학 외과학교실
남영수 ( Nam Young-Soo )
한양대학교 의과대학 외과학교실
백홍규 ( Baik Hong-Kyu )
한양대학교 의과대학 외과학교실
이홍기 ( Lee Hong-Gee )
한양대학교 의과대학 외과학교실
이흥우 ( Lee Heung-Woo )
한양대학교 의과대학 외과학교실
조석주 ( Cho Seog-Ju )
한양대학교 의과대학 외과학교실
김상우 ( Kim Sang-Woo )
한양대학교 의과대학 외과학교실
이광수 ( Lee Kwong-Soo )
한양대학교 의과대학 외과학교실
KMID : 0371320010610020148
Abstract
Purpose
The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4
year
period of experience with LA and describes various unusual findings encountered during the treatment.
Methods
From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed
in all
the cases presented here.
Results
All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure
and the
remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with
non-catecholamine-
secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first
oral
intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases.
Conclusion
LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular
complications
and of the problems inherent in the manipulation of the adrenal gland during LA.
키워드
복강경 부신절제술; 경복막 접근법; Laparoscopic adrenalectomy; Transabdominal lateral approach;
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