Brunaud Laurent, Kebebew Electron, Sebag Frederic, Zarnegar Rasa, Clark Orlo H, Duh Quan-Yang
Department of Surgery, University California San Francisco and Mount Zion Medical Center, Mount Zion Medical Center, San Francisco, CA, USA.
Med Sci Monit. 2006 Sep;12(9):CR355-62.
The optimal strategy remains controversial for adrenal incidentaloma, 4 to 6 cm in size, nonfunctioning, and without malignant imaging characteristics. A decision analysis model was used to identify relevant variables for selecting the optimal management (observation versus adrenalectomy).
MATERIAL/METHODS: Risk/benefit analysis in tertiary care center. The probabilities of each health outcome states were determined by a review of the literature from 1980 to 2002 (n=2844 patients); and from a retrospective review of experience at University of California San Francisco (UCSF).
The baseline probabilities of morbidity after laparoscopic unilateral adrenalectomy and a new indication developing during initial observation (hypersecretion, size increase, malignancy) were 7.8% and 3.1%, respectively. We found observation to be the preferred approach when using baseline probabilities and utilities. Laparoscopic adrenalectomy becomes the preferred approach however if: (1) The morbidity rate from laparoscopic unilateral adrenalectomy is < 3.0%, 2) The probability of a new indication developing for adrenalectomy during observation is > 7.5%, 3) A patient's perspective of observation has a utility of lower than 98.6%, and (4) A patient views having a complication from adrenalectomy is not much deleterious (utility > 88.1%).
This decision analysis model identifies the important variables for selecting the optimal management approach for adrenal incidentalomas. These results can be used to select the optimal management strategy based on individual patient preference and surgeon-specific complication rate.
对于直径4至6厘米、无功能且无恶性影像学特征的肾上腺偶发瘤，最佳治疗策略仍存在争议。我们使用决策分析模型来确定选择最佳治疗方案（观察还是肾上腺切除术）的相关变量。
材料/方法：在三级医疗中心进行风险/效益分析。通过回顾1980年至2002年的文献（n = 2844例患者）以及对加利福尼亚大学旧金山分校（UCSF）的经验进行回顾性分析，确定每种健康结局状态的概率。
腹腔镜单侧肾上腺切除术后发病的基线概率以及初始观察期间出现新指征（分泌亢进、体积增大、恶性肿瘤）的概率分别为7.8%和3.1%。我们发现，使用基线概率和效用值时，观察是首选方法。然而，如果出现以下情况，腹腔镜肾上腺切除术则成为首选方法：（I）腹腔镜单侧肾上腺切除术的发病率<3.0%；（2）观察期间因新指征而行肾上腺切除术的概率>7.5%；（3）患者对观察的接受度效用值低于98.6%；（4）患者认为肾上腺切除术的并发症危害不大（效用值>88.1%）。
该决策分析模型确定了选择肾上腺偶发瘤最佳治疗方法的重要变量。这些结果可用于根据患者个体偏好和外科医生特定的并发症发生率来选择最佳治疗策略。
