腹腔镜肾上腺切除术治疗巨大肾上腺肿块：挑战还是常规手术？

Laparoscopic adrenalectomy for large adrenal masses: a challenge or a routine?

作者信息

Maestroni U, Vicente D, Del Rio P, Ziglioli F, Dinale F, Campobasso D, Ferretti S, Stojadinovic A, Avital I

机构信息

Department of Surgery University Hospital of Parma, Parma, Italy -

出版信息

Minerva Chir. 2014 Apr;69(2):59-64.

PMID:24847892

Abstract

AIM

The increased incidence of malignancy and the concern for higher rate of complications with laparoscopic resection of larger tumors typically limits laparoscopic adrenalectomy to small adrenal masses. We used our prospectively collected database to compare laparoscopic adrenalectomy outcomes between small and large adrenal tumors.

METHODS

Operative details and outcomes were compared by adrenal mass size size: Group A≤4 cm and Group B>4 cm, for consecutive laparoscopic adrenalectomies performed between 2009 and 2013.

RESULTS

Group A (N.=50) and Group B (N.=27) subjects had similar operative times (131 vs. 132 min, P=0.48). Group B subjects were older, had more adrenal malignancies, and had a higher blood loss with a slightly larger change in hemoglobin than Group A subjects; however, no subject required blood transfusion and complication rates were similar between groups (4% vs. 11%, P=0.34). One subject from each group required conversion to open adrenalectomy.

CONCLUSION

Laparoscopic adrenalectomy can be performed safely for adrenal masses >4 cm and size is not a contraindication to the laparoscopic approach.

摘要

目的

恶性肿瘤发病率的增加以及对较大肿瘤行腹腔镜切除术时较高并发症发生率的担忧，通常将腹腔镜肾上腺切除术限制于较小的肾上腺肿块。我们使用前瞻性收集的数据库比较小肾上腺肿瘤和大肾上腺肿瘤行腹腔镜肾上腺切除术的结果。

方法

对于2009年至2013年间连续进行的腹腔镜肾上腺切除术，根据肾上腺肿块大小将手术细节和结果进行比较：A组≤4 cm，B组>4 cm。

结果

A组（n = 50）和B组（n = 27）患者的手术时间相似（131分钟对132分钟，P = 0.48）。B组患者年龄较大，肾上腺恶性肿瘤更多，失血量更多，血红蛋白变化略大于A组患者；然而，两组均无患者需要输血，并发症发生率相似（4%对11%，P = 0.34）。每组各有1例患者需要转为开放性肾上腺切除术。