van Heerden J A, Young W F, Grant C S, Carpenter P C
Department of Gastroenterologic, Mayo Clinic, Rochester, Minn 55905, USA.
Surgery. 1995 Apr;117(4):466-72. doi: 10.1016/s0039-6060(05)80069-8.
Patients with endogenous hypercortisolism are thought to be at high risk for adrenalectomy and may experience significant postoperative surgical mortality/morbidity.
From 1981 through 1991, 91 patients underwent adrenal resection for endogenous hypercortisolism. Causes were adrenal-dependent Cushing's syndrome (50%), pituitary-dependent Cushing's syndrome (27%), and an ectopic adrenocorticotropic hormone-secreting tumor (23%). Causes of adrenal-dependent Cushing's syndrome were adrenocortical adenoma (72%), bilateral nodular hyperplasia (20%), and adrenocortical carcinoma (8%). Comparative mean length of hospitalization for patients undergoing unilateral anterior versus posterior approach was 8 versus 6 days, and bilateral anterior versus posterior was 11 versus 6 days.
Operative mortality was 2.6%. Only one patient had a wound infection, and no patient had either a venous thrombosis or a pulmonary embolism. Delayed wound healing occurred in three patients.
(1) Adrenal surgery can be performed today with low morbidity/mortality. (2) Although there is an effect of hypercortisolism on wound healing, infection, diabetes, hypertension, coronary artery disease, and pulmonary embolism, it was possible to perform adrenalectomy surgically with acceptable morbidity and mortality. (3) These results may serve as a standard against which laparoscopic adrenalectomy may be compared.
内源性皮质醇增多症患者被认为肾上腺切除术风险高，术后可能出现显著的手术死亡率/发病率。
1981年至1991年，91例患者因内源性皮质醇增多症接受肾上腺切除术。病因包括肾上腺依赖性库欣综合征（50%）、垂体依赖性库欣综合征（27%）和异位促肾上腺皮质激素分泌肿瘤（23%）。肾上腺依赖性库欣综合征的病因包括肾上腺皮质腺瘤（72%）、双侧结节性增生（20%）和肾上腺皮质癌（8%）。单侧前路与后路手术患者的平均住院时间比较为8天对6天，双侧前路与后路手术患者为11天对6天。
手术死亡率为2.6%。仅1例患者发生伤口感染，无患者发生静脉血栓形成或肺栓塞。3例患者出现伤口愈合延迟。
（1）如今肾上腺手术的发病率/死亡率较低。（2）尽管皮质醇增多症对伤口愈合、感染、糖尿病、高血压、冠状动脉疾病和肺栓塞有影响，但仍有可能以可接受的发病率和死亡率进行肾上腺切除术。（3）这些结果可作为与腹腔镜肾上腺切除术进行比较的标准。
