Urologic Oncology Branch, National Cancer Institute and Section on Neuroendocrinology, National Institute of Child Health and Human Development (BBS, KP), National Institutes of Health, Bethesda, Maryland, USA.
J Urol. 2010 Jul;184(1):18-25. doi: 10.1016/j.juro.2010.03.052.
Many patients with small adrenal masses undergo total adrenalectomy. We evaluated partial adrenalectomy outcomes by performing a comprehensive literature review.
We performed a PubMed search of the English language literature using the queries partial adrenalectomy and adrenal sparing surgery, and identified 317 and 155 articles, respectively. We excluded case reports or series with fewer than 5 patients, articles not focused on surgical management and those that did not indicate perioperative outcomes. The remaining articles were cross-referenced by author and institution to eliminate studies with redundant cases. Demographics, diagnosis, tumor characteristics, perioperative and functional outcomes, and recurrence data were collected when available.
A total of 22 articles from a total of 22 first authors met our inclusion criteria, describing outcomes in a total of 417 patients. There has been an increasing trend toward partial adrenalectomy worldwide in the last 20 years. Partial adrenalectomy is most commonly done for Conn's syndrome, followed by pheochromocytoma. Most procedures are laparoscopic with minimal morbidity. The recurrence rate is only 3% and more than 90% of patients remain steroid independent.
Partial adrenalectomy surgical outcomes and perioperative complications are similar to those reported for total adrenalectomy. When partial adrenalectomy is done for small adrenal lesions, the malignancy rate is negligible, the recurrence rate is low and most patients remain steroid-free at long-term followup. These data strongly support the acceptance of partial adrenalectomy as first line treatment for small adrenal masses.
许多患有小肾上腺肿块的患者接受了全肾上腺切除术。我们通过全面的文献回顾评估了部分肾上腺切除术的结果。
我们使用“部分肾上腺切除术”和“肾上腺保留手术”这两个查询词，在 PubMed 上进行了英文文献搜索，分别找到了 317 篇和 155 篇文章。我们排除了病例报告或少于 5 例的病例系列、未聚焦于手术管理的文章以及未说明围手术期结果的文章。通过作者和机构交叉引用，排除了具有冗余病例的研究。收集了可用的人口统计学、诊断、肿瘤特征、围手术期和功能结果以及复发数据。
共有 22 位作者的 22 篇文章符合我们的纳入标准，共描述了 417 例患者的结果。在过去的 20 年中，全球范围内部分肾上腺切除术呈上升趋势。部分肾上腺切除术最常用于 Conn 综合征，其次是嗜铬细胞瘤。大多数手术都是腹腔镜的，发病率很低。复发率仅为 3%，超过 90%的患者仍然不需要类固醇。
部分肾上腺切除术的手术结果和围手术期并发症与全肾上腺切除术相似。当对小的肾上腺病变进行部分肾上腺切除术时，恶性肿瘤的发生率可以忽略不计，复发率较低，大多数患者在长期随访中无需使用类固醇。这些数据有力地支持了将部分肾上腺切除术作为小肾上腺肿块的一线治疗方法。
