Delis Spiros G, Bakogiannis Andreas, Ciancio Gaetano, Soloway Mark
Liver Surgical Unit, 1 Surgical Department, Agia Olga Hospital, Athens, Greece.
BJU Int. 2008 Nov;102(10):1394-9. doi: 10.1111/j.1464-410X.2008.07792.x. Epub 2008 Jun 6.
To report our experience in the surgical management of patients with large adrenal masses and describe the key steps in performing radical resections, which are especially demanding where thrombi extend into the inferior vena cava (IVC).
From 2003 to 2007, 14 patients presented with large adrenal mass, and underwent surgical extirpation. In five patients thrombi extended into the IVC, causing Budd-Chiari syndrome in one.
The median (range) patient age was 48 (40-58) years. The excision was radical with negative tumour margins in all cases. Cardiopulmonary bypass (CPB) was required in one case with adherent intra-atrial thrombus. The mean blood loss was 500 (250-1500) mL except in the patient who required CPB. Morbidity included pleural effusion (three patients) and postoperative pneumonia (two), which responded to conservative management. All patients were alive and free of disease at a median follow-up of 12 (5-42) months.
Surgical extirpation of large adrenal masses requires technical experience to optimize outcome. Total tumour excision is the only therapeutic option in such cases and provides acceptable results in survival and quality of life.
报告我们对肾上腺巨大肿块患者进行外科治疗的经验，并描述根治性切除术的关键步骤，尤其是在血栓延伸至下腔静脉（IVC）的情况下，这一手术极具挑战性。
2003年至2007年，14例肾上腺巨大肿块患者接受了手术切除。其中5例血栓延伸至IVC，1例导致布加综合征。
患者年龄中位数（范围）为48（40 - 58）岁。所有病例切除彻底，切缘肿瘤阴性。1例心房内血栓粘连患者需要体外循环（CPB）。除需要CPB的患者外，平均失血量为500（250 - 1500）毫升。并发症包括胸腔积液（3例）和术后肺炎（2例），经保守治疗后好转。所有患者在中位随访12（5 - 42）个月时均存活且无疾病。
肾上腺巨大肿块的手术切除需要技术经验以优化治疗效果。在这种情况下，完整切除肿瘤是唯一的治疗选择，并且在生存和生活质量方面能提供可接受的结果。
