Heniford B T, Iannitti D A, Hale J, Gagner M
Department of General Surgery, Cleveland Clinic Foundation, OH 44195, USA.
Surgery. 1997 Dec;122(6):1068-73; discussion 1073-4. doi: 10.1016/s0039-6060(97)90210-5.
The role of laparoscopic intraoperative ultrasonography (IOUS) in intraoperative decision making has grown rapidly in recent years. The purpose of this study was to evaluate its usefulness during laparoscopic adrenalectomy.
Since 1995, laparoscopic ultrasonography has been used to evaluate the adrenal gland and surrounding organs in selective laparoscopic adrenalectomies. IOUS was performed in 19 of 114 laparoscopic adrenalectomies.
IOUS effected a change in management in 68% of these patients. IOUS displayed the location of the gland after a failed attempt at open resection; the adrenal vein, expediting control in four operations; no extraadrenal involvement by two large lesions (benign); vascular invasion in one tumor (carcinoma), prompting open resection; periadrenal invasion by one metastatic cancer and lymph node involvement in another; a 7 mm hyperaldosteronoma; no adenoma in two cases; bilateral hyperplasia; and a 14 cm cyst originating from the adrenal gland. IOUS facilitated partial adrenalectomy in two patients and revealed centrally located adenomas in two others requiring total adrenalectomy.
Laparoscopic IOUS during adrenal operation is valuable in selected cases. It is helpful to locate the gland and vein, confirm the presence or absence of abnormality, discern the resectability of large masses, and facilitate a partial adrenalectomy when desirable.
近年来，腹腔镜术中超声检查（IOUS）在术中决策中的作用迅速增强。本研究的目的是评估其在腹腔镜肾上腺切除术中的效用。
自1995年以来，腹腔镜超声已用于在选择性腹腔镜肾上腺切除术中评估肾上腺及周围器官。在114例腹腔镜肾上腺切除术中的19例中进行了IOUS检查。
IOUS使这些患者中的68%改变了治疗方式。IOUS显示了开放切除尝试失败后肾上腺的位置；肾上腺静脉，在4例手术中加快了控制；两个大的病变（良性）未出现肾上腺外侵犯；一个肿瘤（癌）出现血管侵犯，促使转为开放切除；一例转移性癌出现肾上腺周围侵犯，另一例出现淋巴结受累；一个7毫米的醛固酮瘤；两例未发现腺瘤；双侧增生；以及一个起源于肾上腺的14厘米囊肿。IOUS帮助两名患者进行了部分肾上腺切除术，并在另外两名需要全肾上腺切除术的患者中发现了位于中央的腺瘤。
肾上腺手术中的腹腔镜IOUS在特定病例中具有价值。它有助于定位肾上腺和肾上腺静脉，确认有无异常，判断大肿块的可切除性，并在需要时协助进行部分肾上腺切除术。
