Ramani Anup P, Abreu Sidney C, Desai Mihir M, Steinberg Andrew P, Ng Christopher, Lin Chia-Hsiang, Kaouk Jihad H, Gill Inderbir S
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Urology. 2003 Aug;62(2):223-6. doi: 10.1016/s0090-4295(03)00366-2.
To report our experience with laparoscopic partial nephrectomy for renal tumor with concomitant adrenalectomy. An upper pole renal tumor may contiguously involve the adrenal gland, requiring concomitant adrenalectomy. Although commonly performed in the setting of laparoscopic radical nephrectomy, concomitant adrenalectomy has not been described during laparoscopic partial nephrectomy.
Four patients with an upper pole renal tumor and suspected adrenal involvement underwent laparoscopic partial nephrectomy with concomitant ipsilateral adrenalectomy. Preoperative three-dimensional computed tomography revealed the renal tumor to be closely abutting the adrenal gland in 3 patients and a 4-cm adrenal mass in 1 patient. The mean renal tumor size was 3.2 cm (range 1.4 to 6.6). To maintain oncologic principles, our transperitoneal laparoscopic technique excises the adrenal gland en bloc with the renal tumor. As such, adrenalectomy is performed first, followed by partial nephrectomy, incorporating hilar control, tumor excision, and sutured renal reconstruction.
All four procedures were performed without open conversion or intraoperative complications. The mean renal warm ischemia time was 36 minutes, estimated blood loss 169 mL, total operating time 3.9 hours, and hospital stay 3.2 days. One patient developed a transient urinary leak postoperatively. Pathologic examination of the renal tumor revealed renal cell carcinoma (n = 1), dystrophic calcification with ectopic bone formation (n = 1), adult mesoblastic nephroma (n = 1), and subcapsular heterotopic adrenal cortex with cyst (n = 1), all with negative surgical margins. Pathologic examination of the adrenal gland revealed adenoma in 1 case and a normal adrenal gland without malignant involvement in 3 cases. All patients were disease free at last follow-up (mean 6.2 months, range 2 to 12).
In patients with an upper pole renal tumor and radiologically suspected adrenal involvement, laparoscopic partial nephrectomy with concomitant adrenalectomy can be performed efficaciously respecting oncologic principles.
报告我们对合并肾上腺切除术的肾肿瘤行腹腔镜部分肾切除术的经验。肾上极肾肿瘤可能会连续累及肾上腺，需要同时进行肾上腺切除术。虽然在腹腔镜根治性肾切除术时肾上腺切除术很常见，但在腹腔镜部分肾切除术期间尚未有相关描述。
4例肾上极肾肿瘤且怀疑肾上腺受累的患者接受了腹腔镜部分肾切除术并同期行同侧肾上腺切除术。术前三维计算机断层扫描显示，3例患者的肾肿瘤紧邻肾上腺，1例患者有一个4厘米的肾上腺肿块。肾肿瘤平均大小为3.2厘米（范围1.4至6.6厘米）。为遵循肿瘤学原则，我们的经腹腹腔镜技术将肾上腺与肾肿瘤整块切除。因此，先进行肾上腺切除术，然后是部分肾切除术，包括肾门控制、肿瘤切除和缝合肾重建。
所有4例手术均未转为开放手术，也未发生术中并发症。平均肾热缺血时间为36分钟，估计失血量169毫升，总手术时间3.9小时，住院时间3.2天。1例患者术后出现短暂尿漏。肾肿瘤的病理检查显示肾细胞癌（n = 1）、伴有异位骨形成的营养不良性钙化（n = 1）、成人中胚叶肾瘤（n = 1）和伴有囊肿的包膜下异位肾上腺皮质（n = 1），所有病例手术切缘均为阴性。肾上腺的病理检查显示1例为腺瘤，3例肾上腺正常无恶性累及。所有患者在最后一次随访时均无疾病（平均6.2个月，范围2至12个月）。
对于肾上极肾肿瘤且影像学怀疑肾上腺受累的患者，在遵循肿瘤学原则的情况下，可有效地进行腹腔镜部分肾切除术并同期行肾上腺切除术。
