Clinical Analysis Of Laparoscopic Adrenal Surgery

Objective:To evaluated the prevalence of the surgical diseases of adrenal gland, and to summarize the application of laparoscopic adrenal surgery. To investigate the prevalence and treatment of adrenal incidentaloma.Methods:Statistics of the annual data of patients with adrenal gland diseases was made, included the classification and constituent ratio of surgical adrenal diseases, and demography by retrospective analysis of the patients with surgical adrenal diseases in Tianjin Medical University General Hospital from the year 1999 to 2009. The applications of laparoscopic operation v.s open operation, the successful rate of laparoscopic adrenalectomy, the incidence rate of conversion and the complications was evaluated. The indications v.s contraindications of laparoscopic adrenal surgery was discussed. The prevalence, pathological classification dignosis and treatment of adrenal incidentaloma was dicussed.Results:Female patients were more than male in the team of 837 patients of surgical adrenal diseases, and the ratio of male and female was 1:1.55. The age of the patients were from 11 to 78, and the proportion from 30 to 60 was 84.8% which occupied the majority. In the 3 common types of adrenal diseases, primary aldosteronism (33.9%) was more than the others, while the prevalence of hyper-catecholamine was 15.5% and hypercortisolism was 10.2%. Though there was an apparent increment of primary aldosteronism, more epidemiological data should be made to confirm it. In the overall 654 laparoscopic adrenalectomy, transperitoneal approach was 11, and retroperitoneal approach was 643. It seemed that retroperitoneal approach was proper for most patients of adrenal gland diseases. Beside the regular laparoscopic adrenal operations, 5 patients accepted re-laparoscopic adrenalectomy, and all of them were successful, which might append the indication of laparoscopic operations. The achievement ratio of the laparoscopic operations in this team was 98.8%, and the occurrence rate of conversion to open surgery was 1.2%. There were minor complication in 41 cases, and severe complication in 4 cases (1 case of injury to colon,1 case of pancreatic injury and intraabdominal hemorrhage,2 cases of retroperitoneal active bleeding). Overall mobidity of complication was 6.74%, and only 0.59% cases were severe complication that needed open operation.The cases of adrenal incidentaloma were 22.34% in all the inpatients of adrenal disease, and its proportion annually increased.44.96% cases of adrenal incidentaloma were diagnosed in routine physical examination. In the 187 cases of adrenal incidentaloma,165 cases were subjected to operations (66.7% were laparoscopic operations), and the other 22 cases (11.8%) were followed up. In the followed-up 22 cases, there were patients of testified and asymptomatic adrenal cyst, adrenal myelolipoma, nonfunctional adrenal cortical adenoma or nodular hyperplasia, metastatic carcinoma, and the cases of uncertain tumor while the patients were in poor condition.Conclusions:Surgical adrenal diseases were more common in female patients than in male. And it was common in 30 to 69 years-old patients, and approximately occupied a proportion of 85%. In the 3 common types of adrenal diseases, primary aldosteronism (33.9%) was the most, followed by pheochromacytoma (15.5%) and hypercortisolism (10.2%).The indication of laparoscopic adrenal surgery expanded in more than a decade since its application in adrenal surgery. Obesity, large adrenal tumors, re-laparoscopic operations and malignant adrenal tumors ceased to be contraindications for well experienced surgons of laparoscopy. Laparoscopic adrenalectomy was the first choice of operation on surgical adrenal diseases.There was also remarkable increment of proportion of adrenal incidentaloma in all the inpatients of adrenal diseases. More and more patients of adrenal incidentaloma were diagnosed by physical examination. In this group,44.96% patients of adrenal incidentaloma were diagnosed by routine physical examination. Not all the patients of adrenal incidentaloma need subject to operation, those who had testified and asymptomatic adrenal cyst, small than 3-4 cm adrenal myelolipoma and nonfunctional adrenal cortical adenoma, should be watchful waiting.