| Objective(s):To compare the perioperative period and prognosis of unilateral functional adrenocortical adenoma treated by retroperitoneal approach partial adrenalectomy and total adrenalectomy,and to explore the clinical efficacy of the two surgical methods,providing the basis for the selection of surgical methods of functional adrenocortical adenomas.Simultaneous analysis and discussion of the relationship between microfocal lesions and recurrence after partial adrenalectomy.Methods:Retrospectively analyzed the postoperative pathological data of 293 adrenal neoplasm patients undergoing laparoscopic adrenal surgery from the Second Affiliated Hospital of Kunming Medical University between October 2015 and January 2018,collected the clinical data of 173 patients witch pathological type is adrenal cortical adenoma,according to clinical symptoms and laboratory findings 107 patients with functional adrenal adenoma were included in the study.The subjects included 81 patients with APA and 26 patients with CS adenomas.,according to the different surgical methods adopted,patients in the Primary aldosteronism group and Cushing group were subdivided into partial adrenalectomy group and total adrenalectomy group.Collect all of the patients clinical data including age,sex,clinical symptoms,tumor size,preoperative blood pressure,potassium,hormone levels,intraoperative blood loss,operative time,postoperative extubation time,postoperative discharge time and postoperative follow-up of blood pressure,potassium,improve clinical symptoms,tumor recurrence,and compared to the above data analysis,comparing two surgery clinical curative effect.In order to define the cortical adenoma with microfocal lesions,a random sample of 52 patients with preoperative imaging diagnosis of adrenal adenoma(33 cases of postoperative pathology confirmed for adrenal cortical adenoma),of removal of living tissue to adenoma is bounded into the adrenal adenoma distributed around tumors and tumors had normal adrenal tissue pathologic examination,to postoperative adrenal adenoma with ’statistics,analysis of the adrenal glands around sebaceous gland tumors with hyperplastic nodule and the relationship between the recurrence after the resection of adrenal gland.Results:Postoperative pathological findings of adrenocortical adenomas in 173 patients with 293 adrenal tumors,43 cases of adrenocortical hyperplasia,21 cases of pheochromocytoma,19 cases of myelolipoma,18 cases of adrenal cyst,8 cases of ganglioneuroma,3 cases of lymphangioma,2 cases of adrenocortical carcinoma,2 cases of adrenal tuberculosis,1 case of paraganglioma,1 case of leiomyosarcoma,and 1 case of postoperative pathology showed that the ectopic tissue of the pancreas.Among 173 cases of adrenal gland adenomas,there were 51 cases of functional adenomas and 122 cases of functional adrenal adenomas,8 cases were diagnosed as bilateral adrenal adenomas by preoperative imaging,7 cases were lost to follow-up,and 107 cases were subsequently included in the study group,81 cases of APA and 26 cases of CS adenoma.All the 107 patients were successfully operated without transfer to open surgery and no intraoperative blood transfusion.In the APA adenoma group,49 cases were in the total excision group and 32 cases were in the partial excision group.In the CS adenoma group,there were 16 cases in the total excision group and 10 cases in the partial excision group.There was no statistically significant difference between patients undergoing partial resection and total resection in the APA adenoma group include gender,age,tumor size,tumor side,preoperative blood pressure,preoperative blood potassium,preoperative plasma aldosterone concentration,plasma renin activity,ARR,intraoperative blood loss,operative time,postoperative extubation time,discharge time,Intraoperative and postoperative complications(P>0.05).The preoperative data of all patients with APA were combined with different degrees of hypertension.In the median follow-up period of 14(2-27)months of follow-up,17 patients in the partial resection group had normal blood pressure,12 had blood pressure relief,3 had no effect on blood pressure,30 had normal blood pressure in the total resection group,and 19 had blood pressure relief.There was no statistically significant difference between the two groups(P>0.05).Both groups of patients reexamined serum potassium within 3 months after surgery.Adrenal total cut group APA patients 13 cases of limb weakness symptoms all follow-up after remission,26 cases of headache,dizziness symptoms were relieved in 23 cases,APA patients in partial adrenalectomy group,9 cases of postoperative limb weakness,8 cases eased,17 cases of headache,dizziness symptoms eased in 15 cases,which was no significant difference in postoperative clinical symptom remission rates between the two groups(P>0.05).In the partial resection group,1 patient returned to the hospital for review 2 years after surgery,and CT showed that there was a recurrent adenoma of the side,and the recurrence after partial resection was considered.There was no significant difference in patients with partial resection and total resection in the CS adenoma group include gender,age,tumor size,preoperative blood pressure,preoperative cortisol hormone levels,intraoperative blood loss,operative time,postoperative extubation time,discharge time,intraoperative and postoperative complications,etc.(P>0.05).8 cases of resection group and 14 cases of all patients with preoperative hypertension,the median time was 14(2-27)months follow-up period,partial nephrectomy group 5 cases blood pressure returned to normal,2 cases of blood pressure relief,1 case of blood pressure treatment is invalid,the group of 9 cases of blood pressure returned to normal,subtotal resection in 5 cases of blood pressure relief,the results between the two groups has no statistical significance(P>0.05).CS partial adrenalectomy grouplO patients with adenoma of centrality obesity,13 cases with clear moon face,7 cases of postoperative centripetal obesity and 10 patients with full moon face of symptoms,partial adrenalectomy group 7 cases had symptoms of centrality obesity,in patients with symptoms of 9 cases with full moon face,5 cases of centrality obesity and 8 cases of postoperative moon face of symptoms,and clinical symptom remission rate difference between the two has no statistical significance(P>0.05).No recurrence of the tumor was found after follow-up.Nine out of 107 patients had clinical manifestations of postoperative lack of corticosteroids such as fatigue,spasticity,and high fever,including 4 patients with APA adenoma,3 patients with full-cut,and 1 patient with partial resection,the postoperative incidence of cortical hormone deficiency contrast no statistical significance(P>0.05).Five patients in the CS adenoma group had postoperative corticosteroid insufficiency,and 4 patients underwent total excision,and 1 patient had partial resection,and the comparison(P>0.05)was not statistically significant.The incidence of postoperative corticosteroid insufficiency in patients with APA and CS adenomas(4.9%vs 19.2%)was P=0.037.33 cases of postoperative disease tissue distribution of the disease inspection adenomas in patients with pathological results showed that 22 cases with hyperplasia or nodular hyperplasia,there is no separate send disease inspection of 140 patients with a total of 15 patients with adrenal adenoma tips with hyperplasia or nodular hyperplasia,both in terms of micro lesions with rate comparison(P<0.05).Conclusion(s):1.Adrenal cortical adenoma is the most common type of adrenal pathology in the clinic,and APA is the most common functional adrenal adenoma.2.Laparoscopic surgery is effective in improving the clinical symptoms caused by functional adrenal adenomas.3.Posterior laparoscopic partial adrenalectomy is technically safe and reliable,otherwise there is no advantage in reducing the incidence of postoperative corticosteroid insufficiency and there is a risk of postoperative recurrence due to residual adrenal tissue associated with proliferative nodules.4.The incidence of corticosteroid insufficiency after CS adenoma was higher than APA.5.The rate of hyperplasia or nodular hyperplasia was significantly increased in patients who had adenomas and peripheral adrenal tissues sent separately for pathological examination,compared with the pathological results of patients who were routinely examined. |
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