Kang Thomas, Gridley Asahel, Richardson William S
Department of General Surgery, Ochsner Clinic Foundation , New Orleans, Louisiana.
J Laparoendosc Adv Surg Tech A. 2015 Mar;25(3):182-6. doi: 10.1089/lap.2014.0430. Epub 2015 Feb 5.
Laparoscopic adrenalectomy is the gold standard procedure for most adrenal masses. However, long-term data regarding this procedure are limited. We report our institution's experience with laparoscopic adrenalectomy, determine if this procedure results in durable weight loss and resolves hypertension, diabetes mellitus, or hyperlipidemia, and identify predictors of pathology in nonfunctioning tumors.
We retrospectively reviewed laparoscopic adrenalectomies performed for adrenal masses between May 2000 and September 2010 by nine surgeons at a single institution. Data gathered included demographics, body mass index (BMI), preoperative and postoperative imaging and biochemical testing results, length of stay, complications, pathology, medications, and resolution of hypertension, diabetes, or hyperlipidemia.
We removed 96 adrenal glands in 95 patients. Their average age was 55.6 years. The average length of stay was 1.8 days. Average BMI was 32.9 kg/m(2) preoperatively and 31.9 kg/m(2) postoperatively (P=.46). We experienced no conversions to open procedure and no perioperative mortality. Minor complications occurred at a rate of 1.2%. Indications for adrenalectomy were nonfunctioning tumor (n=35), pheochromocytoma (n=18), aldosteronoma (n=17), subclinical Cushing's syndrome (n=15), Cushing's syndrome (n=9), and sex hormone-secreting tumor (n=1). Hypertension improved or resolved in 63% of patients with Cushing's syndrome, 56% with aldosteronoma, and 47% with pheochromocytoma. When adrenalectomy was performed for nonfunctioning tumors, neoplasia was identified in 22.9% of patients. The most predictive factors for neoplasia were previous history of cancer and abnormal appearance on computed tomography, magnetic resonance imaging, or positron emission tomography scan.
Laparoscopic adrenalectomy is a safe procedure with a low complication rate and short hospital stay. Hypertension improves in the majority of patients with Cushing's syndrome and aldosteronoma and just under the majority of those with pheochromocytoma. In our study, abnormal radiologic appearance was a better predictor of neoplasia than size.
腹腔镜肾上腺切除术是大多数肾上腺肿块的金标准手术。然而，关于该手术的长期数据有限。我们报告我们机构开展腹腔镜肾上腺切除术的经验，确定该手术是否能带来持久的体重减轻并解决高血压、糖尿病或高脂血症问题，并确定无功能肿瘤的病理预测因素。
我们回顾性分析了2000年5月至2010年9月期间，由单一机构的9名外科医生为肾上腺肿块实施的腹腔镜肾上腺切除术。收集的数据包括人口统计学资料、体重指数（BMI）、术前和术后的影像学及生化检测结果、住院时间、并发症、病理、用药情况以及高血压、糖尿病或高脂血症的缓解情况。
我们为95例患者切除了96个肾上腺。他们的平均年龄为55.6岁。平均住院时间为1.8天。术前平均BMI为32.9kg/m²，术后为31.9kg/m²（P = 0.46）。我们没有转为开放手术的情况，也没有围手术期死亡。轻微并发症发生率为1.2%。肾上腺切除术的适应证包括无功能肿瘤（n = 35）、嗜铬细胞瘤（n = 18）、醛固酮瘤（n = 17）、亚临床库欣综合征（n = 15）、库欣综合征（n = 9）和分泌性激素肿瘤（n = 1）。63%的库欣综合征患者、56%的醛固酮瘤患者和47%的嗜铬细胞瘤患者的高血压得到改善或缓解。当为无功能肿瘤进行肾上腺切除术时，22.9%的患者发现有肿瘤形成。肿瘤形成的最具预测性的因素是既往癌症病史以及计算机断层扫描、磁共振成像或正电子发射断层扫描的异常表现。
腹腔镜肾上腺切除术是一种安全的手术，并发症发生率低，住院时间短。大多数库欣综合征和醛固酮瘤患者以及略低于半数的嗜铬细胞瘤患者的高血压得到改善。在我们的研究中,放射学异常表现比肿瘤大小更能预测肿瘤形成。
