The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD, 21231, USA.
Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA.
Abdom Radiol (NY). 2019 Jan;44(1):140-153. doi: 10.1007/s00261-018-1669-y.
Adrenalectomy is the standard of care for management of many adrenal tumor types and, in the United States alone, approximately 6000 adrenal surgeries are performed annually. Two general approaches to adrenalectomy have been described; (1) the open approach, in which a diseased adrenal is removed through a large (10-20 cm) abdominal wall incision, and (2) the minimally invasive approach, in which laparoscopy is used to excise the gland through incisions generally no longer than 1-2 cm. Given these disparate technique options, clear preoperative characterization of those specific disease features that inform selection of adrenalectomy approach is critically important to the surgeon. Because most of these features are directly assessed via preoperative abdominal imaging, in particular computed tomography (CT) scanning, a clear mutual understanding among surgeons and radiologists of those adrenal tumor features impacting operative approach selection is vital for planning adrenal surgery. In this context, we review the preoperative CT imaging features that specifically inform adrenalectomy approach selection, provide illustrative examples from our institution's imaging and surgical archives, and provide a stepwise guide to both the open and laparoscopic adrenalectomy approaches.
肾上腺切除术是许多肾上腺肿瘤类型的标准治疗方法，仅在美国，每年就有约 6000 例肾上腺手术。肾上腺切除术有两种常用方法：（1）开放手术，通过一个 10-20cm 的大腹部切口切除患病的肾上腺；（2）微创手术，通过腹腔镜通过不超过 1-2cm 的切口切除腺体。鉴于这些不同的技术选择，明确术前描述哪些特定的疾病特征会影响肾上腺切除术的选择对于外科医生来说至关重要。由于这些特征大多可以通过术前腹部成像，特别是计算机断层扫描（CT）扫描直接评估，因此外科医生和放射科医生之间对影响手术方法选择的肾上腺肿瘤特征有明确的共识，对于规划肾上腺手术至关重要。在这种情况下，我们回顾了专门用于告知肾上腺切除术方法选择的术前 CT 成像特征，从我们机构的影像学和手术档案中提供了示例，并提供了开放和腹腔镜肾上腺切除术方法的分步指南。
