Pediatric Surgery Unit, Women's and Children's Health Department, University of Padova, Padova, Italy.
Department of Pediatric Surgery, Necker Enfants-Malades Hospital-Université Paris Descartes, Sorbonne Paris Cite, Paris, France.
Surg Endosc. 2017 Nov;31(11):4505-4512. doi: 10.1007/s00464-017-5506-0. Epub 2017 May 26.
Minimal access adrenal surgery (MAAS) for adrenal pathologies is the standard for many pediatric surgical centers. However, the literature offers few reports and minimal evidence from small case series. The aim of this study was to evaluate the outcomes of pediatric MAAS through a multi-center data analysis.
Pediatric patients who underwent MAAS between January 2002 and December 2013 were retrospectively included. Data analysis was conducted using Spss software (Welch's t-test, X-square, Fisher tests, multiple regression model).
Six European centers participated, 68 patients were included with mean age of 5.2 years (2 months-16 years). Lesion volume was of 18.1 cc (0.78-145.6), with a mean diameter of 2.8 cm (1.1-6.5). Localization was 50% left-sided masses, 45.6% right-side masses, and 4.4% bilateral. Histological examination revealed 36 neuroblastomas, 15 adenomas, nine pheochromocytomas, three ganglioneuromas, two ganglioneuroblastomas, one bilateral hyperplasia, one adrenocortical carcinoma, an alveolar sarcoma, and a calcification. Surgical access was transperitoneal in 63 (92.6%) and retroperitoneal in 5 (7.4%). Mean operative time was 170 ± 87 min (285 ± 30 min for bilateral lesions). Mean hospital stay was 4.2 ± 2.5 days. Complications included blood loss requiring transfusion in five patients (7.4%) and a diaphragmatic tear. Infiltration of surrounding structures correlated with intraoperative complication rate (p = 0.027) and operative time (p < 0.01). No mass rupture, conversion, or post-operative complications were observed. Median follow-up was 52 months (1-161). Two recurrences occurred in patients with pheochromocytoma. Age, weight, symptoms, characteristics at imaging, chemistry, volume, or histology, did not influence operative time, hospital stays, or complication rate.
Pediatric MAAS was safe adopted for masses up to 145.6 cc, with a very low rate of complication. Conversion to open is not necessary even in the presence of infiltrations. MAAS should represent the first-line treatment for selected cases in centers experienced in laparoscopy.
微创肾上腺手术（MAAS）是许多儿科手术中心治疗肾上腺疾病的标准方法。然而，文献中很少有报道，也很少有来自小病例系列的证据。本研究的目的是通过多中心数据分析评估小儿 MAAS 的结果。
回顾性纳入 2002 年 1 月至 2013 年 12 月期间接受 MAAS 的儿科患者。使用 Spss 软件进行数据分析（Welch's t 检验、X 平方检验、Fisher 检验、多元回归模型）。
六个欧洲中心参与，共纳入 68 例患者，平均年龄 5.2 岁（2 个月至 16 岁）。病变体积为 18.1cc（0.78-145.6），平均直径为 2.8cm（1.1-6.5）。定位为 50%左侧肿块，45.6%右侧肿块，4.4%双侧。组织学检查显示 36 例神经母细胞瘤、15 例腺瘤、9 例嗜铬细胞瘤、3 例节细胞神经瘤、2 例节细胞神经母细胞瘤、1 例双侧增生、1 例肾上腺皮质癌、1 例肺泡肉瘤和 1 例钙化。63 例（92.6%）采用经腹腔入路，5 例（7.4%）采用经腹膜后入路。平均手术时间为 170±87 分钟（双侧病变的平均手术时间为 285±30 分钟）。平均住院时间为 4.2±2.5 天。并发症包括 5 例（7.4%）需要输血的失血和膈肌撕裂。周围结构浸润与术中并发症发生率（p=0.027）和手术时间（p<0.01）相关。未观察到肿块破裂、转为开放或术后并发症。中位随访时间为 52 个月（1-161）。2 例嗜铬细胞瘤患者复发。年龄、体重、症状、影像学特征、化学、体积或组织学均不影响手术时间、住院时间或并发症发生率。
小儿 MAAS 安全用于最大 145.6cc 的肿块，并发症发生率很低。即使存在浸润，也不需要转为开放手术。在有经验的腹腔镜中心，MAAS 应成为选定病例的一线治疗方法。
