Li Pingchu, Shi Hongjin, Zheng Yanghuang, Yang Jiaxin, Zeng Dan, Qiu Ming, Wang Haifeng, Ruan Zhifang, Chang Lingdan, Fu Shi, Yang Fabin, Zhang Jinsong
Department of Urology, Surgical Ward One, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Respiratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming Medical College, Kunming, China.
Gland Surg. 2024 Dec 31;13(12):2274-2287. doi: 10.21037/gs-24-345. Epub 2024 Dec 27.
The selection and extent of application for both total adrenalectomy (TA) and partial adrenalectomy (PA) within this surgical approach continue to be matters of debate. This paper compares the postoperative efficacy and functional indicators of PA and TA to provide comprehensive insights for clinicians to consider the best surgical treatment options.
Systematic review on PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure (CNKI) was conducted. We compared several key factors between TA and PA, including operating time (OT), blood loss, length of hospital stay, serum aldosterone levels, plasma renin activity, postoperative aldosterone to renin ratio (ARR), systolic and diastolic blood pressure, early postoperative complications, and blood potassium concentration. Data were collected by the Cochran-Mantel-Haenszel method, and Review Manager software (RevMan) version 5.3 was used.
The results showed that compared to TA, PA had a shorter OT [weighted mean difference (WMD) =-12.16; 95% confidence interval (CI): -19.42, -4.89; I=96%; P=0.001]. Compared with PA, TA had a better recovery of diastolic blood pressure (WMD =2.12; 95% CI: 0.42, 3.81; I=0%; P=0.01). Regarding serum aldosterone, plasma renin activity, postoperative ARR, systolic blood pressure, early postoperative complications, length of hospital stay, and blood potassium, there was no significant difference between PA and TA (P>0.05). In subgroup analysis, results indicated that there was currently no significant difference in most results between PA and TA (P>0.05). For patients aged 50 years or younger, PA had a shorter OT compared to TA (WMD =-19.71; 95% CI: -35.99, -3.42; I=95%; P=0.02). For tumor size ≤2.0 cm, the intraoperative blood loss of PA was greater than that of TA (WMD =16.76; 95% CI: 3.62, 29.90; I=37%; P=0.01).
The OT was shorter in PA than in TA, and shorter in younger patients. The recovery of diastolic blood pressure after TA was better than that of PA. When the tumor was 2 cm or small, TA had less blood loss than PA. There was no significant difference in functional indexes between PA and TA. PA offers advantages in surgical outcomes compared to TA. However, for tumors ≤2 cm, TA may provide greater benefits to patients. Additionally, TA demonstrates superior recovery of diastolic blood pressure compared to PA according to functional indicators.
在这种手术方式中，全肾上腺切除术（TA）和部分肾上腺切除术（PA）的选择及应用范围仍是存在争议的问题。本文比较了PA和TA的术后疗效及功能指标，为临床医生考虑最佳手术治疗方案提供全面的见解。
对PubMed、Embase、Cochrane图书馆、Web of Science和中国知网（CNKI）进行系统评价。我们比较了TA和PA之间的几个关键因素，包括手术时间（OT）、失血量、住院时间、血清醛固酮水平、血浆肾素活性、术后醛固酮与肾素比值（ARR）、收缩压和舒张压、术后早期并发症以及血钾浓度。数据采用Cochran-Mantel-Haenszel方法收集，并使用Review Manager软件（RevMan）5.3版。
结果显示，与TA相比，PA的OT更短[加权平均差（WMD）=-12.16；95%置信区间（CI）：-19.42,-4.89；I=96%；P=0.001]。与PA相比，TA的舒张压恢复更好（WMD =2.12；95%CI：0.42,3.81；I=0%；P=0.01）。关于血清醛固酮、血浆肾素活性、术后ARR、收缩压、术后早期并发症、住院时间和血钾，PA和TA之间无显著差异（P>0.05）。在亚组分析中，结果表明目前PA和TA在大多数结果上无显著差异（P>0.05）。对于50岁及以下的患者，与TA相比，PA的OT更短（WMD =-19.71；95%CI：-35.99,-3.42；I=95%；P=0.02）。对于肿瘤大小≤2.0 cm，PA的术中失血量大于TA（WMD =16.76；95%CI：3.62,29.90；I=37%；P=0.01）。
PA的OT比TA短，且年轻患者更短。TA术后舒张压的恢复优于PA。当肿瘤为2 cm或更小时，TA的失血量比PA少。PA和TA之间的功能指标无显著差异。与TA相比，PA在手术结果方面具有优势。然而，对于肿瘤≤2 cm的患者，TA可能为患者带来更大的益处。此外，根据功能指标，TA的舒张压恢复优于PA。
