Brunt L M, Moley J F, Doherty G M, Lairmore T C, DeBenedetti M K, Quasebarth M A
Department of Surgery, Section of Endocrine and Oncologic Surgery, Washington University School of Medicine, St Louis, Mo 63110, USA.
Surgery. 2001 Oct;130(4):629-34; discussion 634-5. doi: 10.1067/msy.2001.116920.
Laparoscopic adrenalectomy (LA) has become the preferred method of removal of most adrenal neoplasms, but few studies have evaluated the functional outcomes of this approach. The purpose of this study was to analyze our operative results and the clinical and biochemical responses to LA in patients with various hormonally active adrenal tumors.
From 1993 through November 2000, 72 patients with functional adrenal tumors underwent attempted LA. Data were obtained retrospectively by review of medical records, during routine follow-up, and by patient questionnaire.
Indications for adrenalectomy were pheochromocytoma (n = 35), aldosteronoma (n = 29), cortisol-producing adenoma (n = 5), and adrenocorticotropic hormone-dependent Cushing's syndrome (n = 3). LA was completed in 70 of 72 patients, with 2 conversions (3%) to open adrenalectomy. Mean operative time for unilateral LA was 176 +/- 60 minutes, and postoperative length of hospital stay averaged 3.0 +/- 1.7 days. Complications, most of which were minor, occurred in 19% of patients; there were no serious complications or perioperative deaths. Two patients were unavailable for follow-up. At a mean follow-up interval of 37.6 months after LA (range, 2-90 months), resolution of clinical and biochemical signs of adrenal hyperfunction was accomplished in 34 of 34 patients with pheochromocytomas, 25 of 26 patients with aldosteronomas, 5 of 5 patients with cortisol-producing adenomas, and 3 of 3 patients with andrenocorticotropic hormone-dependent Cushing's syndrome. Two patients with multiple endocrine neoplasia (MEN) type 2 had contralateral pheochromocytomas removed 4 and 5 years after the initial surgery. Persistent hypertension necessitating medication was present in 72% of patients with aldosteronomas, although 92% of these patients had improved blood pressure control after LA. Recurrent hypokalemia developed in 1 patient (4%) with a cortical nodule in the contralateral adrenal. No local or distant tumor recurrences have occurred.
LA results in an excellent clinical outcome in patients with various functional endocrine tumors. LA is associated with few major complications, and clinical and biochemical cure rates are comparable with those of open adrenalectomy during long-term follow-up.
腹腔镜肾上腺切除术（LA）已成为大多数肾上腺肿瘤切除的首选方法，但很少有研究评估这种方法的功能结局。本研究的目的是分析我们对各种激素活性肾上腺肿瘤患者的手术结果以及对LA的临床和生化反应。
从1993年至2000年11月，72例功能性肾上腺肿瘤患者尝试接受LA。通过查阅病历、常规随访以及患者问卷调查回顾性获取数据。
肾上腺切除术的指征包括嗜铬细胞瘤（n = 35）、醛固酮瘤（n = 29）、分泌皮质醇腺瘤（n = 5）和促肾上腺皮质激素依赖性库欣综合征（n = 3）。72例患者中有70例完成了LA，2例（3%）转为开放性肾上腺切除术。单侧LA的平均手术时间为176±60分钟，术后平均住院时间为3.0±1.7天。19%的患者发生并发症，大多数为轻微并发症；无严重并发症或围手术期死亡。2例患者无法进行随访。在LA后平均随访37.6个月（范围2 - 90个月）时，34例嗜铬细胞瘤患者中的34例、26例醛固酮瘤患者中的25例、5例分泌皮质醇腺瘤患者中的5例以及3例促肾上腺皮质激素依赖性库欣综合征患者中的3例，肾上腺功能亢进的临床和生化体征得到缓解。2例2型多发性内分泌腺瘤（MEN）患者在初次手术后4年和5年切除了对侧嗜铬细胞瘤。72%的醛固酮瘤患者存在持续高血压需要药物治疗，尽管其中92%的患者在LA后血压控制有所改善。1例（4%）对侧肾上腺有皮质结节的患者出现复发性低钾血症。未发生局部或远处肿瘤复发。
LA对各种功能性内分泌肿瘤患者产生了良好的临床结局。LA相关主要并发症少，长期随访期间临床和生化治愈率与开放性肾上腺切除术相当。
