Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan; Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan.
Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Kanagawa, Japan; Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan.
Surgery. 2023 Aug;174(2):234-240. doi: 10.1016/j.surg.2023.04.010. Epub 2023 May 13.
The surgical and endocrinological outcomes of single-port laparoscopic partial adrenalectomy for patients with aldosterone-producing adenomas are unknown. Precise diagnosis of intra-adrenal aldosterone activity and a precise surgical procedure may improve outcomes. In this study, we aimed to determine the surgical and endocrinological outcomes of single-port laparoscopic partial adrenalectomy with preoperative segmental selective adrenal venous sampling and intraoperative high-resolution laparoscopic ultrasound in patients with unilateral aldosterone-producing adenomas. We identified 53 patients with partial adrenalectomy and 29 patients with laparoscopic total adrenalectomy. Single-port surgery was performed for 37 and 19 patients, respectively.
A single-center, retrospective cohort study. All patients with unilateral aldosterone-producing adenomas diagnosed by selective adrenal venous sampling and treated surgically between January 2012 and February 2015 were included. Follow-up with biochemical and clinical assessments was set at 1 year after surgery for short-term outcomes and was performed every 3 months after surgery.
We identified 53 patients with partial adrenalectomy and 29 patients with laparoscopic total adrenalectomy. Single-port surgery was performed for 37 and 19 patients, respectively. Single-port surgery was associated with shorter operative and laparoscopic times (odds ratio, 0.14; 95% confidence interval, 0.039-0.49; P = .002 and odds ratio, 0.13; 95% confidence interval, 0.032-0.57; P = .006, respectively). All single-port and multi-port partial adrenalectomy cases showed complete short-term (median 1 year) biochemical success, and 92.9% (26 of 28 patients) who underwent single-port partial adrenalectomy and 100% (13 of 13 patients) who underwent multi-port partial adrenalectomy showed complete long-term (median 5.5 years) biochemical success. No complications were observed with single-port adrenalectomy.
Single-port partial adrenalectomy is feasible after selective adrenal venous sampling for unilateral aldosterone-producing adenomas, with shorter operative and laparoscopic times and a high rate of complete biochemical success.
经皮单孔腹腔镜下肾上腺部分切除术治疗醛固酮分泌腺瘤的手术和内分泌学结果尚不清楚。术前肾上腺静脉分段选择性采样和术中高分辨率腹腔镜超声检查可提高手术效果。本研究旨在确定单侧醛固酮分泌腺瘤患者经皮单孔腹腔镜下肾上腺部分切除术的手术和内分泌学结果，患者均接受了术前选择性肾上腺静脉采样和术中高分辨率腹腔镜超声检查。我们共纳入 53 例行肾上腺部分切除术和 29 例行腹腔镜全切除术的患者。分别有 37 例和 19 例患者接受了单孔手术。
这是一项单中心回顾性队列研究。纳入 2012 年 1 月至 2015 年 2 月间经选择性肾上腺静脉采样诊断为单侧醛固酮分泌腺瘤并接受手术治疗的所有患者。术后短期随访采用生化和临床评估，术后每 3 个月随访一次。
我们共纳入 53 例行肾上腺部分切除术和 29 例行腹腔镜全切除术的患者。分别有 37 例和 19 例患者接受了单孔手术。单孔手术与较短的手术和腹腔镜时间相关（比值比，0.14；95%置信区间，0.039-0.49；P =.002 和比值比，0.13；95%置信区间，0.032-0.57；P =.006）。所有单孔和多孔肾上腺部分切除术患者术后均达到了短期（中位时间 1 年）生化完全缓解，行单孔肾上腺部分切除术的 28 例患者中有 92.9%（26 例）和行多孔肾上腺部分切除术的 13 例患者中有 100%（13 例）获得了长期（中位时间 5.5 年）生化完全缓解。单孔肾上腺切除术无并发症发生。
对于单侧醛固酮分泌腺瘤患者，经选择性肾上腺静脉采样后行经皮单孔腹腔镜下肾上腺部分切除术是可行的，可获得较短的手术和腹腔镜时间以及较高的生化完全缓解率。
