Aporowicz Michał, Domosławski Paweł, Czopnik Piotr, Sutkowski Krzysztof, Kaliszewski Krzysztof
1 Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Arch Med Sci. 2018 Aug;14(5):1010-1019. doi: 10.5114/aoms.2018.77257. Epub 2018 Jul 20.
The perioperative complication rate of adrenalectomy varies between 1.7% and 30.7% in the medical literature. This study presents outcomes of adrenalectomy in our center and tries to point out risk factors for perioperative problems.
We retrospectively analyzed all patients who underwent adrenalectomy in our department from January 2004 to June 2015. Patient's sex, indication for procedure, tumor laterality, surgical approach and surgeon's case volume were taken into consideration as possible risk factors for complications.
There were 177 adrenalectomies performed on 170 patients. We reported 18 (10.2%) perioperative complications, 12 (6.8%) surgical and 6 (3.4%) medical. Laparotomy was a significant risk factor for medical ( < 0.01) and overall problems ( = 0.02). Operations more expansive than just adrenalectomy were associated with higher risk of medical complications ( = 0.01). Procedures performed by surgeons with higher volume were associated with smaller risk of medical complications ( < 0.01). Right and left adrenalectomies seem to be related to different kinds of risk - bleeding on the right, injury of surrounding structures on the left ( = 0.05). Patient's sex, indication for procedure, bilateral procedure and side of operation were not statistically significant risk factors for complications.
Adrenal glands are surrounded by various anatomic structures (colon, pancreas, spleen, diaphragm) that may be injured during adrenalectomy. Complications following a laparoscopic procedure may arise from the use of monopolar coagulation and the patient's position on the operating table. High insufflation pressure during retroperitoneoscopic procedures may cause subcutaneous emphysema.
医学文献中肾上腺切除术的围手术期并发症发生率在1.7%至30.7%之间。本研究展示了我们中心肾上腺切除术的结果，并试图指出围手术期问题的风险因素。
我们回顾性分析了2004年1月至2015年6月在我科接受肾上腺切除术的所有患者。将患者的性别、手术指征、肿瘤位置、手术方式和外科医生的手术量作为可能的并发症风险因素进行考量。
对170例患者实施了177例肾上腺切除术。我们报告了18例（10.2%）围手术期并发症，其中12例（6.8%）为手术相关并发症，6例（3.4%）为医疗相关并发症。开腹手术是医疗相关并发症（<0.01）和总体并发症（=0.02）的显著风险因素。比单纯肾上腺切除术范围更广的手术与更高的医疗并发症风险相关（=0.01）。由手术量较大的外科医生实施的手术医疗并发症风险较小（<0.01）。右侧和左侧肾上腺切除术似乎与不同类型的风险相关——右侧出血，左侧周围结构损伤（=0.05）。患者的性别、手术指征、双侧手术和手术侧别不是并发症的统计学显著风险因素。
肾上腺被各种解剖结构（结肠、胰腺、脾脏、膈肌）包围，在肾上腺切除术中这些结构可能会受到损伤。腹腔镜手术后的并发症可能源于单极电凝的使用和患者在手术台上的体位。后腹腔镜手术中过高的气腹压力可能导致皮下气肿。
