Izaki Hirofumi, Fukumori Tomoharu, Takahashi Masayuki, Taue Ryuichi, Kishimoto Tomoteru, Tanimoto Syuji, Nishitani Masa-Aki, Kanayama Hiro-Omi
Department of Urology, The University of Tokushima Graduate School Institute of Health Bioscience, Tokushima, Japan.
Int J Urol. 2006 Jun;13(6):677-81. doi: 10.1111/j.1442-2042.2006.01384.x.
Laparoscopic adrenalectomy is currently indicated for biochemically and clinically functional adrenal tumors and potentially malignant tumors of the adrenal glands. Non-functional adenomas greater than 5 cm in diameter of the adrenal gland are generally considered to represent potentially malignant tumors. The present study shows indications of laparoscopic adrenalectomy for non-functional adrenal tumors with hypertension in a retrospective fashion.
Between 1994 and 2004, 110 laparoscopic adrenalectomies were performed at Tokushima University Hospital. All 110 patients underwent detailed endocrinological examination before surgery. Medical and operative records of these 110 patients (57 men, 53 women), including operative parameters, histopathological findings and pre- and postoperative hypertension, were reviewed. Forty-five patients underwent laparoscopic adrenalectomy for non-functional adrenal tumors, and [(131)I]6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol (NP-59) scintigraphy was performed for patients with preoperative hypertension.
Mean patient age was 55.0 years (range, 22-77 years). Mean maximum tumor diameter was 42 mm (range, 20-105 mm). All adrenal tumors were removed successfully by laparoscopic surgery. Hypertension was postoperatively improved in seven of the 11 patients with preoperative hypertension, without subclinical Cushing syndrome. Importantly, all patients who improved hypertension after adrenalectomy displayed strong accumulation in adrenal tumors with visualization of the contralateral gland on NP-59 scintigraphy. Conversely, blood pressure did not improve in four patients for whom scintigraphy yielded negative results.
The indication of laparoscopic adrenalectomy for non-functional adrenal tumors is generally considered for lesions more than 5 cm diameter. However, the present study suggests that laparoscopic surgery should be considered even in patients with tumors less than 5 cm in diameter, if both hypertension and accumulation in tumors on NP-59 scintigraphy are present.
目前，腹腔镜肾上腺切除术适用于具有生化和临床功能的肾上腺肿瘤以及肾上腺潜在恶性肿瘤。肾上腺直径大于5 cm的无功能腺瘤通常被认为代表潜在恶性肿瘤。本研究以回顾性方式展示了腹腔镜肾上腺切除术治疗伴有高血压的无功能肾上腺肿瘤的指征。
1994年至2004年期间，德岛大学医院共进行了110例腹腔镜肾上腺切除术。所有110例患者在手术前均接受了详细的内分泌检查。回顾了这110例患者（57例男性，53例女性）的医疗和手术记录，包括手术参数、组织病理学结果以及术前和术后的高血压情况。45例患者因无功能肾上腺肿瘤接受了腹腔镜肾上腺切除术，对术前高血压患者进行了[(131)I]6β-碘甲基-19-去甲胆甾-5(10)-烯-3β-醇（NP-59）闪烁扫描。
患者平均年龄为55.0岁（范围22 - 77岁）。肿瘤平均最大直径为42 mm（范围20 - 105 mm）。所有肾上腺肿瘤均通过腹腔镜手术成功切除。11例术前高血压患者中有7例术后高血压得到改善，且无亚临床库欣综合征。重要的是，所有肾上腺切除术后高血压得到改善的患者在NP-59闪烁扫描中显示肾上腺肿瘤有强烈聚集，对侧腺体可见。相反，4例闪烁扫描结果为阴性的患者血压未改善。
对于无功能肾上腺肿瘤，腹腔镜肾上腺切除术的指征一般认为是直径大于5 cm的病变。然而，本研究表明，即使肿瘤直径小于5 cm，如果同时存在高血压且NP-59闪烁扫描显示肿瘤有聚集，也应考虑腹腔镜手术。
