原发性肾上腺大肿瘤的内镜治疗

Endoscopic treatment of large primary adrenal tumours.

作者信息

Walz M K, Petersenn S, Koch J A, Mann K, Neumann H P H, Schmid K W

机构信息

Department of Surgery and Centre of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany.

出版信息

Br J Surg. 2005 Jun;92(6):719-23. doi: 10.1002/bjs.4964.

DOI:10.1002/bjs.4964

PMID:15856491

Abstract

BACKGROUND

Endoscopic adrenalectomy has become the treatment of choice for small benign adrenal tumours but should not be used for malignant lesions. It is debatable whether large and therefore potentially malignant primary adrenal tumours should be removed by minimally invasive techniques.

METHODS

Three hundred and eighty primary adrenal tumours in 368 patients (142 male and 226 female; mean(s.d.) age 48.9(14.4) years) were excised by laparoscopic or retroperitoneoscopic adrenalectomy. Adrenal neoplasias exceeded 6 cm in diameter (range 6-13 cm) in 33 patients (18 male and 15 female; age 42.6(14.2) years).

RESULTS

There were no deaths. Patients with large tumours had an increased conversion rate (P = 0.039), longer operating time (P < 0.001) and greater intraoperative blood loss (P = 0.007) than those with smaller lesions, but a similar overall morbidity rate (P = 0.207). Six malignant tumours were identified (diameter 4-10 cm; four phaeochromocytomas and two adrenocortical carcinomas). Local recurrence developed in two patients and distant metastasis occurred in all six patients with malignant lesions.

CONCLUSION

Endocopic adrenalectomy perfomed by an experienced surgeon should be the treatment of choice for tumours exceeding 6 cm in diameter.

摘要

背景

内镜下肾上腺切除术已成为治疗小型良性肾上腺肿瘤的首选方法，但不适用于恶性病变。对于大型且因此可能为恶性的原发性肾上腺肿瘤是否应采用微创技术切除仍存在争议。

方法

对368例患者（142例男性和226例女性；平均（标准差）年龄48.9（14.4）岁）的380个原发性肾上腺肿瘤进行了腹腔镜或后腹腔镜肾上腺切除术。33例患者（18例男性和15例女性；年龄42.6（14.2）岁）的肾上腺肿瘤直径超过6 cm（范围6 - 13 cm）。

结果

无死亡病例。与较小肿瘤患者相比，大型肿瘤患者的中转率增加（P = 0.039），手术时间更长（P < 0.001），术中失血量更大（P = 0.007），但总体发病率相似（P = 0.207）。共识别出6例恶性肿瘤（直径4 - 10 cm；4例嗜铬细胞瘤和2例肾上腺皮质癌）。2例患者出现局部复发，所有6例恶性病变患者均发生远处转移。