Liao Chun-Hou, Chueh Shih-Chieh, Lai Ming-Kuen, Hsiao Po-Jen, Chen Jun
Division of Urology, Department of Surgery, Cardinal Tien Hospital, 231 Taipei, Taiwan.
J Clin Endocrinol Metab. 2006 Aug;91(8):3080-3. doi: 10.1210/jc.2005-2420. Epub 2006 May 23.
Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors.
Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed.
All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5-12 cm), operative time 207 min (115-315 min), and blood loss 75 ml (minimal-1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group.
LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.
对于大型、潜在恶性肾上腺肿瘤，腹腔镜肾上腺切除术（LA）存在争议。我们报告了一系列针对大型（>5 cm）肾上腺肿瘤的LA或手辅助LA手术。
在6年中进行的210例LA手术中，39例患者患有直径大于5 cm的潜在恶性肿瘤。对他们的围手术期和随访数据进行了回顾性分析。
所有39例患者LA手术均成功，无围手术期死亡、转为开放手术或在解剖过程中出现包膜破裂。肿瘤平均大小为6.2 cm（范围5 - 12 cm），手术时间207分钟（115 - 315分钟），失血量75 ml（最少 - 1400 ml）。并发症包括1例术中膈肌穿孔、3例轻度伤口感染和1例肺炎。术前有27例无功能肿瘤、7例嗜铬细胞瘤、3例分泌皮质醇的肿瘤和2例男性化肿瘤。最终病理显示8例恶性肿瘤（4例肾上腺皮质癌和4例转移癌）和31例良性肿瘤（14例皮质腺瘤、8例嗜铬细胞瘤、6例髓脂肪瘤和3例神经节神经瘤）。中位随访时间为39个月。4例患者（2例肾上腺皮质癌、1例转移性肝癌和1例淋巴瘤）分别在术后24、10、9和3个月死亡。10例患者使用了手辅助装置。手辅助组仅肿瘤尺寸更大且术后住院时间更长。
当技术上可行且无局部侵犯证据时，LA是选定的大型肾上腺肿瘤的合理选择。如果术中遇到困难解剖，手辅助LA是转为开放手术的良好替代方法。
