Surgical Experience Of Complex Adrenal Tumors And Retrospective Analysis Of 68 Cases

Objective: Laparoscopic surgery is the primary way to treat adrenal tumors,but the removal of giant complicated adrenal tumor is controversial.Through retrospectively analysis of 68 cases of complicated adrenal tumors to compare the clinical curative effect between open surgery and laparoscopic surgery in the treatment of complex adrenal tumors.Materials and methods: Retrospective analysis of 68 cases of complicated adrenal tumor(tumor diameter?6cm)in our center from March 2012 to August2017.67 patients were completed the operation,including 51 cases of laparoscopic surgery and 17 cases of open surgery.One case was not completed due to extensive metastasis.Observation indicators include: 1.The basic information: patient age,gender,tumor size,tumor location,surgical resection time,pathological results.2.During the operation indicators included: operation time,operative blood loss,transfusion blood volume.3.Postoperative observation: occurrence of complications,ventilation time,feeding time,length of hospitalization,and follow-up.4.Compared the related indexes of laparoscopic surgery with open surgery.5.Compared the related indexes of laparoscopic surgery and retroperitoneal laparoscopic surgery.Results: 1.Compared with the open group,the basic information was not statistically significant.2.Laparoscopic surgery group,on average,shorter than open group(2.1±0.6h vs.4.3±1.3h,p<0.05),the average intraoperative blood loss of laparoscopic group significantly less than the open group(210±50ml vs.1090±500ml,p<0.05),for the first time the meal time(13.2±5.1 vs.35.7±8.9h,p<0.05),the aeration time(12.6±4.5h vs.33.2±6.6h,p<0.05),hospitalization days(15.3±2.1 vs.23.2±4.2 days,p<0.05),postoperative follow-up from 5 to 60 months,1 case of extensive metastasis patients died within 1 month after discharge,the rest have no tumor recurrence during the follow-up period.3.Compared with opensurgery,laparoscopic surgery adrenal crisis occurence has no difference.The incidence of incision infection and incisional hernia after open surgery is high,but the laparoscopic surgery is easy to produce subcutaneous emphysema.4.Results of postoperative pathological examination show: 11 cases of myeloid lipoma;13 cases of adrenal cortical adenoma,4 cases of malignant cortical adenocarcinoma;24 cases of pheochromocytoma(35.8%);1 case of adrenal cortical cyst;9 cases of paraganglioma;1 case of neuroblastoma;4 cases of adrenal metastatic carcinoma(Renal cell carcinoma).5.There was no significant difference between the two types of laparoscopic surgery.Conclusion: 1.Laparoscopic surgical resection of the complex adrenal tumor with a diameter larger than 6cm is a safe and effective treatment,but requires adequate preoperative preparation.2.Pheochromocytoma was accounted for 35.8%of the complex adrenal tumors,and preoperative preparation was necessary for the preoperative preparation of complicated adrenal tumors.3.There was no significant difference between transperitoneal resection and roperitoneal resection.but due to the hierarchy of anatomical,the latter need higher surgical skills.