Laparoscopic adrenalectomy for potentially malignant adrenal tumors greater than 5 centimeters
Laparoscopic adrenalectomy for potentially malignant adrenal tumors greater than 5 centimeters
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DOI：
10.1210/jc.2005-2420
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发表时间：
2006-08-01
影响因子：
5.8
通讯作者：
Chen, Jun
中科院分区：
文献类型：
--
作者：
Liao, Chun-Hou;Chueh, Shih-Chieh;Chen, Jun
目的：腹腔镜肾上腺切除术（LA）是有争议的大，潜在的恶性肿瘤。我们报告了一系列的LA或手辅助LA为大（> 5厘米）adrenal tumor.Patients和方法：在210 LAs在6年，39例患者有潜在的恶性肿瘤直径大于5厘米。他们的围手术期和随访资料进行了回顾性分析。结果：所有39例患者都成功LAs无围手术期死亡，转换为开放手术，或剥离过程中囊破裂。平均肿瘤大小为6.2 cm（范围，5 - 12 cm），手术时间为207 min（115 - 315 min），失血量为75 ml（最少1400 ml）。并发症包括1例术中血管穿孔、3例轻度伤口感染和1例肺炎。术前有27个无功能的肿瘤，7个嗜铬细胞瘤，3个皮质醇分泌肿瘤和2个男性化肿瘤。最终病理结果显示8例恶性肿瘤（4例肾上腺皮质癌和4例转移癌）和31例良性肿瘤（14例皮质腺瘤，8例嗜铬细胞瘤，6例骨髓脂肪瘤和3例节细胞神经瘤）。中位随访时间为39个月。4例患者（2例肾上腺皮质癌、1例转移性肝癌和1例淋巴瘤）分别在术后24、10、9和3个月死亡。10例患者使用了手辅助装置。只有肿瘤的大小较大，术后住院时间较长的手assisted group.Conclusions：LA是一个合理的选择，为选定的大型肾上腺肿瘤时，完全切除术在技术上是可行的，并没有证据表明局部浸润。如果术中遇到困难的夹层，手助LA是开放转换的良好替代方法。
Purpose: Laparoscopic adrenalectomy ( LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (> 5 cm) adrenal tumors.Patients and Methods: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed.Results: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm ( range, 5 - 12 cm), operative time 207 min ( 115 - 315 min), and blood loss 75 ml ( minimal 1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant ( four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors ( 14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients ( two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group.Conclusions: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.