PDF(Pubmed)
Abstract：
BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has several advantages over transabdominal laparoscopic adrenalectomy regarding operating time, blood loss, postoperative pain, and recovery. However, postoperatively several patients report chronic pain or hypoesthesia. We hypothesized that these symptoms may be the result of damage to the subcostal nerve, because it passes the surgical area.
METHODS: A prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry.
RESULTS: A total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain.
CONCLUSIONS: In this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high.
METHODS: A prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry.
RESULTS: A total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain.
CONCLUSIONS: In this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high.
摘要：
背景：后腹腔镜肾上腺切除术在手术时间方面优于经腹腹腔镜肾上腺切除术，失血,术后疼痛,和恢复。然而,一些患者在术后报告慢性疼痛或感觉减退。我们假设这些症状可能是肋下神经损伤的结果，因为它通过了手术区.
方法：对没有术前疼痛或腹壁麻木的成年患者进行了前瞻性单中心病例系列研究。患者接受术前和术后问卷调查，并在手术前和术后直接对肋下神经和腹壁肌肉进行高分辨率超声扫描。在第6周的临床评估用重复问卷进行，体检,和高分辨率超声波。通过问卷调查评估长期康复情况，和患者的照片检查腹壁不对称。
结果：共25例患者纳入研究。无手术并发症。所有患者都可以在术前观察肋下神经。在6周,超声显示15例患者神经损伤,神经损伤和术后疼痛之间没有显著关联。然而,神经损伤与感觉减退之间存在显着关联（p=0.01），感官(p<0.001)，体格检查时运动功能障碍(p<0.001)。经过18个月的中位随访，5名患者仍然感到麻木或肌肉无力，一名患者出现慢性术后疼痛。
结论：在这个输出病例系列中，肋下神经术后损伤的发生率，临床和放射学，后腹腔镜肾上腺切除术后为60％。与疼痛无关，自发恢复率高。
方法：对没有术前疼痛或腹壁麻木的成年患者进行了前瞻性单中心病例系列研究。患者接受术前和术后问卷调查，并在手术前和术后直接对肋下神经和腹壁肌肉进行高分辨率超声扫描。在第6周的临床评估用重复问卷进行，体检,和高分辨率超声波。通过问卷调查评估长期康复情况，和患者的照片检查腹壁不对称。
结果：共25例患者纳入研究。无手术并发症。所有患者都可以在术前观察肋下神经。在6周,超声显示15例患者神经损伤,神经损伤和术后疼痛之间没有显著关联。然而,神经损伤与感觉减退之间存在显着关联（p=0.01），感官(p<0.001)，体格检查时运动功能障碍(p<0.001)。经过18个月的中位随访，5名患者仍然感到麻木或肌肉无力，一名患者出现慢性术后疼痛。
结论：在这个输出病例系列中，肋下神经术后损伤的发生率，临床和放射学，后腹腔镜肾上腺切除术后为60％。与疼痛无关，自发恢复率高。
