Skribek Benjamin, Szabó Anett, Ács Júlia, Hegyi Péter, Mátrai Péter, Nyirády Péter, Ács Nándor, Majoros Attila, Deák Pál Ákos
Department of Interventional Radiology, Semmelweis University, Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Heliyon. 2024 Sep 12;10(19):e37868. doi: 10.1016/j.heliyon.2024.e37868. eCollection 2024 Oct 15.
Aldosterone-producing adenomas cause hypertension in 5-10 % of cases. Laparoscopic adrenalectomy is the gold standard treatment for early-stage adrenal gland tumors, but minimally invasive procedures, such as ablative techniques can also be applied. Therefore, we aimed to compare laparoscopic adrenalectomy and ablation techniques in terms of efficacy and safety in the treatment of benign adrenal gland tumors.
We conducted a systematic search in five databases and included studies comparing the efficacy and safety of ablation techniques and laparoscopic adrenalectomy. We calculated odds ratios (ORs) for eligible studies with binary outcomes, and mean differences (MD) with 95 % confidence intervals (CI) for continuous outcomes.
Five studies focusing on aldosterone-producing adenomas were included in our review. A total of 119 patients at 14 centers underwent ablation, and 161 patients had laparoscopic adrenalectomy. The complication rates (OR: 0.98, CI: 0.35-2.69) were similar in both groups, but among complications, hypertensive crisis (OR: 8.13; CI: 1.14-58.11) was more frequent in the ablative group, and even the success rate of interventions - the resolution of hypertension (OR: 0.30, CI: 0.16-0.56) - was lower in this group. On the other hand, the advantage of ablation was shorter intervention time (MD: 75.64 min; CI: 6.33-144.95), shorter hospital stay (MD: 1.6 days; CI: 0.88-2.31), and less perioperative blood loss (MD: 43.55 ml; CI: 12.07-75.04) compared to laparoscopy.
Laparoscopic adrenalectomy is still the best therapeutic approach, but ablation can be an appropriate alternative option for the treatment of aldosterone-producing adrenal gland tumors.
醛固酮瘤在5%-10%的病例中会导致高血压。腹腔镜肾上腺切除术是早期肾上腺肿瘤的金标准治疗方法，但也可应用诸如消融技术等微创手术。因此，我们旨在比较腹腔镜肾上腺切除术和消融技术在治疗良性肾上腺肿瘤方面的疗效和安全性。
我们在五个数据库中进行了系统检索，并纳入了比较消融技术和腹腔镜肾上腺切除术疗效和安全性的研究。对于二元结局的合格研究，我们计算了比值比（OR），对于连续结局，我们计算了平均差（MD）及其95%置信区间（CI）。
我们的综述纳入了五项聚焦于醛固酮瘤的研究。14个中心的119例患者接受了消融治疗，161例患者接受了腹腔镜肾上腺切除术。两组的并发症发生率（OR：0.98，CI：0.35-2.69）相似，但在并发症中，消融组高血压危象更频繁（OR：8.13；CI：1.14-58.11），甚至该组干预成功率——高血压缓解率（OR：0.30，CI：0.16-0.56）更低。另一方面，与腹腔镜手术相比，消融的优势在于干预时间更短（MD：75.64分钟；CI：6.33-144.95）、住院时间更短（MD：1.6天；CI：0.88-2.31）以及围手术期失血量更少（MD：43.55毫升；CI：12.07-75.04）。
腹腔镜肾上腺切除术仍然是最佳治疗方法，但消融可作为治疗醛固酮瘤的一种合适替代选择。
