Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
J Laparoendosc Adv Surg Tech A. 2024 Feb;34(2):189-198. doi: 10.1089/lap.2023.0160. Epub 2023 Oct 20.
This study aimed to review our surgical experience of laparoscopic adrenalectomy (LA) for adrenal masses in the pediatric age group. The electronic medical records of all patients younger than 18 years of age who underwent LA between 2016 and 2023 were retrospectively reviewed. Children with adrenal tumors localized to the site of origin without evidence of encasement of major vasculature or involvement of adjacent organs were considered for LA. Patients with diagnosis of malignant adrenal tumor on preoperative work-up underwent open adrenalectomy. Data were collected regarding demography, clinical presentation, hormonal workup, imaging, duration of surgery, transfusion requirement, conversion rate, postoperative recovery, duration of intravenous (i.v.) analgesia and hospital stay, pathology, complications, and status at follow-up. Between 2016 and 2023, LA adrenalectomy was performed in 11 patients (6 boys and 5 girls) with a mean age of 46.3 (8-120) months. A functional tumor was detected in 6 (54.5%) children, manifesting clinically with Cushing's syndrome (3), virilization (1), feminization (1), or Conn's syndrome (1). Seven (63.6%) tumors originated from the right adrenal, and 4 (36.4%) from the left adrenal gland. The mean tumor weight and size was 49.1 (10-80) g and 5.6 (3-8) cm, respectively. Histopathology included adrenal adenoma (5), ganglioneuroma (3), ganglioneuroblastoma (1), myelolipoma (1), and intermediate adrenocortical tumor (1). The mean surgery duration was 186.6 (120-265) minutes. Intraoperative blood transfusion was required in 2 (18.2%) patients and none required conversion. Full feeds were resumed at 42.7 (24-60) hours, i.v. analgesia requirement was for 54.5 (36-72) hours and mean hospital stay was 5.1 (3-8) days. All patients were symptom-free with no recurrence at mean follow-up period of 50.6 (3-83) months. In children with well-circumscribed, localized, and noninvasive adrenal tumors, LA is feasible, effective, and safe with all advantages of minimally invasive surgery.
本研究旨在回顾我们在小儿年龄段进行腹腔镜肾上腺切除术（LA）治疗肾上腺肿块的手术经验。回顾性分析了 2016 年至 2023 年间接受 LA 的所有年龄小于 18 岁的患者的电子病历。对于起源于局部、无大血管包绕或邻近器官受累证据的肾上腺肿瘤患儿，考虑行 LA。术前检查诊断为恶性肾上腺肿瘤的患者行开放肾上腺切除术。收集的资料包括人口统计学、临床表现、激素检查、影像学、手术时间、输血需求、转化率、术后恢复、静脉（i.v.）镇痛时间和住院时间、病理学、并发症以及随访情况。2016 年至 2023 年间，对 11 例（6 男 5 女）年龄 46.3（8-120）个月的患儿行 LA 肾上腺切除术。6 例（54.5%）患儿发现功能性肿瘤，临床表现为库欣综合征（3 例）、性早熟（1 例）、性幼稚症（1 例）或Conn 综合征（1 例）。7 例（63.6%）肿瘤起源于右侧肾上腺，4 例（36.4%）起源于左侧肾上腺。肿瘤平均重量和大小分别为 49.1（10-80）g 和 5.6（3-8）cm。组织病理学包括肾上腺腺瘤（5 例）、神经节细胞瘤（3 例）、神经节母细胞瘤（1 例）、骨髓脂肪瘤（1 例）和中间肾上腺皮质肿瘤（1 例）。手术平均时间为 186.6（120-265）分钟。2 例（18.2%）患儿术中输血，无 1 例需要中转开腹。患儿于术后 42.7（24-60）小时开始恢复全流食，静脉镇痛时间为 54.5（36-72）小时，平均住院时间为 5.1（3-8）天。所有患儿在平均随访 50.6（3-83）个月后均无症状，无复发。对于边界清楚、局限性和非侵袭性的肾上腺肿瘤患儿，LA 是可行、有效且安全的，具有微创外科的所有优势。
