Clinical Studies Of Adrenal Tumor Resection (236Cases)

Objective: Surgical treatment of adrenal tumors are mainly two methods. Ourhospital with simple adrenal tumor resection, and foreign scholars use adrenalectomy.Through retrospective analysis of clinical data to further compare the advantages anddisadvantages of these two surgical techniques. In order to improve diagnosis andtreatment.Patients and methods: Selected236patients have adrenal tumors from2008.8to2013.12in our hospital. Collecting blood loss in surgery, operative time, intraoperativeand postoperative complications, postoperative hospital stay, the times of analgesic use,and the type of pathological. And follow-up the changes of blood pressure, serumpotassium and related hormone. Collect appropriate postoperative improvement ofsymptoms and signs. Then statistical analysis.Results: There are no significantly different between the group of laparoscopic andopen surgery (P>0.05). In these four comparisons the average amount of bleeding,blood transfusion number of cases, the times of postoperative analgesic use,postoperative hospital stay were significant differences (P <0.05). The complications insurgery, the two groups were statistically significant in pleural injury (P<0.05).Peritoneal injury, hypertensive crisis, renal vein injury, shock, etc. There was nosignificant contrast in peritoneal injury, hypertensive crisis, renal vein injury and shock(P>0.05). Postoperative complications in the two groups of cases, there was nosignificant difference in retroperitoneal hematoma and thrombosis (P>0.05), in thepostoperative subcutaneous emphysema, wound infection and incisional hernia therewas a significant difference (P>0.05) The pathology report announced that in the groupof non-functional tumors, adrenal pheochromocytoma13cases, adrenal adenoma52 cases, adrenal cyst16cases, medullary lipoma3cases, ganglion cell tumors5cases,retroperitoneal teratoma1case, adrenal nodular hyperplasia8cases. In functional tumorgroup, the type of pheochromocytoma have25cases of pheochromocytoma,3cases ofadenoma, the type of primary aldosteronism have66cases of cortical adenoma,2casesof adrenal hyperplasia, and the type of Cushing’s syndrome have42cases of adenoma.In functional tumors before surgery compared to patients with postoperative bloodpressure was statistically significant (P>0.05), in nonfunctioning it was not statisticallysignificant (P>0.05). Pheochromocytoma patients compared with preoperativeendocrine hormone and6months after surgery have a significant difference (P<0.05).Primary hyperaldosteronism compared with potassium and ARR in preoperative andpostoperative6months have significant difference.(P<0.05) Patients with Cushing’ssyndrome compared with their potassium and plasma cortisol before surgery and6months after surgery have a significant difference (P<0.05). There are191cases ofpostoperative patients were followed up for a mean of31months, during follow-upshowed no tumor recurrence. Pheochromocytoma type,18cases of dizziness andheadache with a significant improvement in one month after surgery,15cases withpalpitations the symptoms improved after3months, one case of retinal changes inpatients followed up to23months but the fundus changes did not improved. Primaryhyperaldosteronism type in the15cases of muscle weakness in patients with significantimprovement in symptoms after six months,4cases of paralytic symptoms significantlyreduced in patients with periodic paralysis,13cases of thirst, polyuria, nocturia patientsbefore surgery significantly improved in1month,17cases of dizziness, headache,postoperative patients within one month of symptoms significantly improved. Type ofCushing’s syndrome,29cases of central obesity followed up one year have a significantimprovement in symptoms,26cases of moon face patient the symptoms improved aftersurgery,32cases of skin purple stripes the purple stripes significantly reduced aftersurgery,5cases of facial acne the acne significantly improved after surgery. Comparedto Western scholars currently widely used adrenalectomy, pure adrenal tumor resectionhas obvious advantages in the incidence of postoperative symptoms in patients with adrenal insufficiency, and does not adversely affect the recurrence.Conclusion: Adrenal tumors is the most common type of urinary tract tumor,functioning tumors have a high incidence than non-functioning tumors. In thehistological classification, the highest incidence of cortical adenoma, followed bypheochromocytoma. For the adrenal tumor single examination method is not exact, itshould be integrated clinical symptoms signs and laboratory tests and imaging studies tocomprehensive evaluation. CT as the preferred in imaging aspects. Compared with opensurgery, laparoscopic adrenalectomy in the average of blood loss, the number of cases ofintraoperative blood transfusion, postoperative analgesic use and postoperative hospitalstay times has obvious advantages, it also has the advantages of low incidence ofpostoperative complications of wound infection, incisional hernia, but there are alsohave disadvantage that the possibility of intraoperative pleural rupture. With theprogress of laparoscopic techniques and the surgeon’s experience continue toaccumulate, laparoscopic surgery has become the treatment of adrenal tumors "goldstandard." For functional adrenal tumors, surgery can significantly improve the state ofhigh blood pressure than before surgery, for endocrine disorders and the clinicalsymptoms caused bu it also have a good effect. Pure adrenal tumor resection withpostoperative recurrence rate, postoperative low incidence of adrenal insufficiencyretain normal adrenal function, reduce the use of cortical hormone replacement therapy,etc., is a safe and effective surgical treatments for adrenal tumors.