Procházka V, Kala Z, Jíra M, Starý K, Bohatá S, Penka I
Chirurgická klinika FN Brno Bohunice a LF MU Brno.
Rozhl Chir. 2012 Apr;91(4):230-4.
Laparoscopic adrenalectomy has become a standard surgical procedure for the most of adrenal gland disorders. Hormonal active adenomas, feochromocytomas even some malignant tumors are the most frequent indications. The number of operations for accidentally diagnosed foci has grown rapidly. It has been suggested to revise recommendations specifying criteria, based on which incidentaloma is indicated for adrenalectomy. The aim of this work is to compare the results of adrenalectomies for hormonal active lesions and incidentalomas.
An analysis of 65 patients who underwent adrenalectomy in the Department of Surgery University Hospital Brno Bohunice from 2005 to 2010. Correlation between preoperative examination outcomes and postoperative histology findings was performed. Furthermore, findings in patients indicated for surgery for hormonally active versus for hormonally inactive suprarenal tumors were compared.
Thirty-eight patients underwent laparoscopic surgery for hormonally active adrenal tumors, one for bilateral metastasses of bronchogenic carcinoma. In 26 cases adrenalectomy was indicated for incidentaloma. Adrenal hyperplasia was the commonest histological finding in the group with hormonally inactive tumors. No carcinoma was detected in this group. In 5 of 19 patients operated for suspective feochromocytoma, the procedure did not result in blood pressure adjustment and feochromocytoma was histologically confirmed in 11 out of the 19 subjects. The size of the tumors was significantly higher in incidentalomas, compared to hormonally active pathologies. No incidentaloma and hypertension subjects experienced alteration in their clinical condition after the procedure.
Laparoscopic adrenalectomy is a standard procedure in the majority of hormonally active focal suprarenal conditions. Patients with accidentally detected suprarenal tumors should be carefully indicated, taking into consideration internal comorbidities and any surgical procedures in a patient's history. The benefit of adrenalectomy for the clinical condition alteration is arguable in incidentalomas. The National Institutes of Health U.S.A. (NIH) consensus guidlines should be strictly followed during the decision making proces. Indication for adrenalectomy in tumors of less than 6 cm and with benign appearance on CT or MRI is not considered rational.
腹腔镜肾上腺切除术已成为大多数肾上腺疾病的标准外科手术。激素活性腺瘤、嗜铬细胞瘤甚至一些恶性肿瘤是最常见的适应证。意外发现病灶的手术数量迅速增加。有人建议修订明确标准的建议，据此确定肾上腺切除术的偶发瘤适应证。这项工作的目的是比较激素活性病变和偶发瘤肾上腺切除术的结果。
对2005年至2010年在布尔诺博胡尼采大学医院外科接受肾上腺切除术的65例患者进行分析。对术前检查结果与术后组织学结果进行相关性分析。此外，比较了因激素活性与激素非活性肾上腺肿瘤而接受手术的患者的检查结果。
38例患者接受了腹腔镜手术治疗激素活性肾上腺肿瘤，1例接受了支气管源性癌双侧转移灶手术。26例患者因偶发瘤接受肾上腺切除术。肾上腺增生是激素非活性肿瘤组最常见的组织学发现。该组未检测到癌。在19例疑似嗜铬细胞瘤手术患者中，5例术后血压未得到调整，19例中有11例经组织学证实为嗜铬细胞瘤。与激素活性病变相比，偶发瘤的肿瘤大小明显更大。偶发瘤和高血压患者术后临床状况均未发生改变。
腹腔镜肾上腺切除术是大多数激素活性肾上腺局灶性疾病的标准手术。对于意外发现肾上腺肿瘤的患者，应仔细评估，考虑其内部合并症和既往手术史。肾上腺切除术对改善偶发瘤临床状况的益处存在争议。在决策过程中应严格遵循美国国立卫生研究院（NIH）的共识指南。对于直径小于6 cm且CT或MRI表现为良性的肿瘤，不建议行肾上腺切除术。
