Iusco D, Sarli L, Di Mauro D, Violi V, Roncoroni L
Department of Surgical Sciences, Medical School, Parma University, Parma.
G Chir. 2007 Oct;28(10):363-6.
The benefits of laparoscopic adrenalectomy for single adrenal lesion have been well documented in literature; less experience though has been reported with simultaneous bilateral laparoscopic adrenalectomy. This operation is indicated in case of primary hypercortisolism caused by bilateral adrenocortical hyperfunction, Cushing's disease after failure of pituitary surgery, ectopic adrenocorticotropic hormone (ACTH) production by a tumour inaccessible for surgical intervention, and pheochromocytoma when it occurs bilaterally in case of multiple endocrine neoplasia type 2A and 2B. Different laparoscopic approaches have been described to perform this operation, such as the "anterior" approach (transperitoneal), the "lateral" approach (transperitoneal and retroperitoneal), and the "posterior" approach (retroperitoneal). We report a case of bilateral laparoscopic adrenalectomy in a 33 years old female affected with bilateral pheochromocytoma due to multiple endocrine neoplasia type 2A treated with a bilateral transperitoneal laparoscopic adrenalectomy and disease free after 18 months follow-up.
腹腔镜肾上腺切除术治疗单发肾上腺病变的益处已在文献中得到充分记载；然而，同期双侧腹腔镜肾上腺切除术的经验报道较少。该手术适用于双侧肾上腺皮质功能亢进引起的原发性皮质醇增多症、垂体手术失败后的库欣病、手术无法干预的肿瘤产生异位促肾上腺皮质激素（ACTH）以及2A和2B型多发性内分泌腺瘤病双侧发生嗜铬细胞瘤的情况。已描述了不同的腹腔镜手术入路来实施该手术，如“前路”入路（经腹腔）、“侧路”入路（经腹腔和腹膜后）以及“后路”入路（腹膜后）。我们报告一例33岁女性双侧嗜铬细胞瘤患者，因2A型多发性内分泌腺瘤病接受双侧经腹腔腹腔镜肾上腺切除术，术后18个月随访无疾病复发。
