Tessier Deron J, Iglesias Rafael, Chapman William C, Kercher Kent, Matthews Brent D, Gorden D Lee, Brunt L Michael
Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA.
Surg Endosc. 2009 Jan;23(1):97-102. doi: 10.1007/s00464-008-9947-3. Epub 2008 Apr 29.
Serious complications of adrenalectomy are rare but the incidence may be underestimated if they occur outside major referral centers. We report five cases of high-grade complications after adrenalectomy that have not been previously described.
The records of five cases of adrenalectomy performed at outside hospitals were reviewed. Four cases were referred for management of complications and one for medical-legal review. The nature of the adrenal lesion, operative approach, complication(s), and subsequent clinical course and complication management were assessed. Both open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) cases were included.
Operative indications were pheochromocytoma (N = 3), aldosteronoma (N = 1), and a nonfunctioning 6-cm hypervascular mass (N = 1). Complications of adrenalectomy included: case 1--complete transection of the porta hepatitis during right LA resulting in hepatic failure requiring emergent liver transplantation; case 2--ligation of the hepatic artery during right OA resulting in recurrent cholangitis and bile duct sclerosis requiring liver transplantation; case 3--ligation of the left ureter during LA resulting in postoperative hydronephrosis and loss of renal function; case 4--loss of left kidney function after OA, likely secondary to renal artery ligation ultimately requiring laparoscopic nephrectomy; case 5--LA of a normal adrenal gland for a 6-cm hypervascular mass thought to be arising from the adrenal gland. Three-month postoperative imaging demonstrated a persistent mass and the patient underwent hand-assisted laparoscopic nephrectomy for a left upper pole renal cell carcinoma that was missed at the time of LA.
Despite the generally low morbidity of adrenalectomy, serious and potentially life-threatening complications can occur. Surgeon inexperience may be a factor in the occurrence of some of these complications which have not been previously described.
肾上腺切除术的严重并发症较为罕见，但如果发生在大型转诊中心之外，其发生率可能被低估。我们报告5例肾上腺切除术后高级别并发症，这些并发症此前尚未见报道。
回顾了在外院进行的5例肾上腺切除术的记录。4例因并发症处理而转诊，1例因医疗法律审查而转诊。评估了肾上腺病变的性质、手术方式、并发症以及随后的临床病程和并发症处理情况。纳入了开放肾上腺切除术（OA）和腹腔镜肾上腺切除术（LA）病例。
手术指征为嗜铬细胞瘤（n = 3）、醛固酮瘤（n = 1）和一个6cm的无功能高血运肿块（n = 1）。肾上腺切除术的并发症包括：病例1——右侧LA期间肝门完全横断，导致肝衰竭，需要紧急肝移植；病例2——右侧OA期间肝动脉结扎，导致复发性胆管炎和胆管硬化，需要肝移植；病例3——LA期间左侧输尿管结扎，导致术后肾积水和肾功能丧失；病例4——OA后左肾功能丧失，可能继发于肾动脉结扎，最终需要腹腔镜肾切除术；病例5——因一个被认为起源于肾上腺的6cm高血运肿块行正常肾上腺LA。术后3个月影像学检查显示肿块持续存在，患者因LA时漏诊的左上极肾细胞癌接受了手辅助腹腔镜肾切除术。
尽管肾上腺切除术的总体发病率较低，但仍可能发生严重且潜在危及生命的并发症。外科医生经验不足可能是其中一些此前未被描述的并发症发生的一个因素。
