Filipponi S, Guerrieri M, Arnaldi G, Giovagnetti M, Masini A M, Lezoche E, Mantero F
Clinica di Endocrinologia, Universita' di Ancona, Italy.
Eur J Endocrinol. 1998 May;138(5):548-53. doi: 10.1530/eje.0.1380548.
To investigate the feasibility, safety and results of laparoscopic transperitoneal adrenalectomies performed with the patient supine, in patients affected by secreting and silent adrenal lesions.
Exclusion criteria were suspected adrenal primary malignancies. Fifty patients (33 women and 17 men; mean age 49.6 years, range 19-75 years) underwent 51 laparoscopic adrenalectomies (one bilateral). After complete endocrinological evaluation, computed tomography or magnetic resonance imaging, or a combination thereof, 14 non-secreting adenomas, 13 aldosterone-producing adenomas, 13 cortisol-producing adenomas, eight phaeochromocytomas (one bilateral), one androgen-secreting adenoma, and two metastases were considered eligible for adrenalectomy. In five patients, associated procedures were performed during surgery.
The lesions ranged in size from 1.5 to 10 cm. There were no intraoperative complications and no blood transfusions were required. The postoperative course was uneventful and painless in all patients. Mean postoperative hospital stay was 2.5 days. In all hypertensive patients, significant improvement or cure of hypertension was observed at follow-up (mean 18 months). In patients with secreting adenomas, normalization of hormone concentrations was obtained after removal of the tumour. In six patients with incidentaloma, the exaggerated 17-hydroxyprogesterone response to ACTH disappeared after surgery.
Secreting and non-secreting adrenal lesions were treated safely by laparoscopy. Relatively small incidentalomas and subclinical hormonally active tumours can be removed by laparoscopy. Early diagnosis enhances prevention and treatment.
探讨在仰卧位患者中进行腹腔镜经腹肾上腺切除术治疗分泌性和无功能肾上腺病变的可行性、安全性及效果。
排除标准为疑似肾上腺原发性恶性肿瘤。50例患者（33例女性和17例男性；平均年龄49.6岁，范围19 - 75岁）接受了51例腹腔镜肾上腺切除术（1例双侧）。在完成内分泌学评估、计算机断层扫描或磁共振成像，或两者结合后，14例无功能腺瘤、13例醛固酮分泌腺瘤、13例皮质醇分泌腺瘤、8例嗜铬细胞瘤（1例双侧）、1例雄激素分泌腺瘤和2例转移瘤被认为适合进行肾上腺切除术。5例患者在手术期间进行了相关手术。
病变大小范围为1.5至10厘米。无术中并发症，无需输血。所有患者术后病程平稳且无疼痛。平均术后住院时间为2.5天。在所有高血压患者中，随访时（平均18个月）观察到高血压有显著改善或治愈。在分泌性腺瘤患者中，切除肿瘤后激素浓度恢复正常。在6例偶发瘤患者中，手术后对促肾上腺皮质激素的17 - 羟孕酮反应过度消失。
腹腔镜手术可安全治疗分泌性和无功能肾上腺病变。相对较小的偶发瘤和亚临床激素活性肿瘤可通过腹腔镜切除。早期诊断有助于预防和治疗。
