单中心经验：腹腔镜经腹腔入路肾上腺切除术治疗大肾上腺肿瘤。
Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience.
机构信息
Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
出版信息
BMC Surg. 2021 Feb 1;21(1):68. doi: 10.1186/s12893-021-01080-y.
BACKGROUND
The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors.
METHODS
We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups.
RESULTS
Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22-22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48-12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis.
CONCLUSIONS
Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor.
TRIAL REGISTRATION
This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.
背景
由于恶性肿瘤的风险和技术难度，腹腔镜肾上腺切除术（LA）在大型（≥6cm）肾上腺肿瘤中的作用存在争议。在这项研究中，我们比较了 LA 治疗大型（≥6cm）和（<6cm）肾上腺肿瘤的围手术期结果和并发症。
方法
我们回顾性分析了 2000 年 4 月至 2019 年 6 月期间在我院行单侧经腹腔 LA 的所有临床资料。根据肿瘤大小将患者分为两组。组 1 患者肿瘤大小<6cm（n=408），组 2 患者肿瘤大小≥6cm（n=48）。比较两组间的人口统计学数据、围手术期结果、并发症和病理报告。
结果
组 2 患者年龄较大（p=0.04）、较瘦（p=0.001）、高血压发生率较低（p=0.001），中位手术时间（75 分钟 vs 120 分钟）、估计出血量（20 毫升 vs 100 毫升）、输血率（0% vs 20.8%）、中转率（0.25% vs 14.6%）和术后住院时间（4 天 vs 5.5 天）均显著升高（均 p<0.001）。组 2 患者术中并发症发生率（4.7% vs 31.3%；调整后的优势比[OR]为 9.67（95%CI 4.22-22.17），p 值<0.001）和术后并发症发生率（5.4% vs 31.3%；调整后的 OR 为 5.67（95%CI 2.48-12.97），p 值<0.001）也显著升高。本研究仅发生 8 例（1.8%）严重并发症。组 2 患者最常见的病理类型是嗜铬细胞瘤和转移瘤。
结论
腹腔镜经腹腔肾上腺切除术治疗≥6cm 的大型肾上腺肿瘤是可行的，但与术中并发症、术后并发症和恢复相关的风险显著增加。然而，大多数并发症是轻微的，可以保守治疗。对于肾上腺手术有经验的外科医生进行仔细的患者选择是腹腔镜手术治疗大型肾上腺肿瘤成功的关键因素。
试验注册
本研究于 2020 年 3 月 2 日在泰国临床试验注册中心进行了回顾性注册。注册号为 TCTR20200312004。
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