Retroperitoneal laparoscopic adrenalectomy for bilateral macronodular adrenal hyperplasia / 中华内分泌外科杂志

ABSTRACT

Objective To discuss the clinical feasibility and significance of retroperitoneal laparoscopic adrenalectomy for bilateral macronodular adrenal hyperplasia.Methods 9 patients with bilateral macronodular adrenal hyperplasia received retroperitoneal laparoscopic operations.5 cases had the typical clinical manif(e)stetions of Cushing's syndrome and 4 patients presented hypertension or diabetes mellitus without any sign of Cushing's syndrome.Body mass index was 18.8-31.2,with 25.0 as the average.Serum cortisol was 544-1746 nmol/L,with 984 nmol/L as the average.Urinary free cortisol (UFC) was 347-1989 nmol/24h with 1129 nmol/24h as the average.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.The size of the adrenal gland was 6 cm × 5 cm × 4 cm to 10 cm × 6 cm× 3 cm,with 8 cm× 5 cm × 4 cm as the average.Results One patient underwent retroperitoneal laparoscopic bilateral adrenalectomy with replantation of adrenal gland tissue in scrotum,1patient underwent right lateral adrenalectomy combined with left subtotal adrenalectomy,4 patients underwent right lateral adrenalectomy ( 1case was converted to open surgery due to hemorrhage),and 3 patients underwent left lateral adrenalectomy.The average operation duration was 116 min,ranging from 60 to 165 min.The estimated average intraoperative blood loss was 110 ml,ranging from 20 to 600 ml.No severe complications like injury in great vessels or organs happened during the operation.Pathological diagnosis showed nodular or adenomatoid hyperplasia of adrenal cortex.The average postoperative follow-up was 58 months,ranging from 12 to 84 months.Clinical symptoms of Cushing's syndrome disappeared after surgery in the 5 cases with typical clinical features of Cushing's syndrome.Body weight and blood glucose recovered to normal level for those 4 cases presenting body weight increasement,hypertension or diabetes mellitus.2 cases with right lateral adrenalectomy received left adrenalectomy 33 and 41months after the first operation due to recurrence of Cushing's syndrome.Conclusions Retroperitoneal laparoscopic adrenalectomy for bilateral macronodular adrenal hyperplasia is technically feasible in experienced hands. Unilateral adrenalectomy can relieve most of the Cushing's symptoms.Bilateral adrenalectomy or unilateral adrenalectomy combined with contralateral subtotal adrenalectomy can be performed if the symptoms are not improved or recurred after unilateral adrenalectomy.