Elektif Laparoskopik Adrenalektomilerde Lateralizasyon Farklılıkları

Öz

Amaç: Laparoskopi, adrenal tümörlerin çıkartılmasında güvenilirliği birçok kez bildirilmiş etkili bir minimal invaziv yöntemdir. Çalışma, laparoskopik adrenalektominin sağ-sol taraf farkına bağlı olarak karşılaşılan klinik özelliklerin gösterilmesini hedeflemektedir.Gereç ve Yöntemler: Çalışmada Ocak 2014 ile Aralık 2018 arasında üniversitemiz genel cerrahi kliniğinde transperitoneal yolla laparoskopik tek taraflı adrenalektomi yapılan erişkin hastalar, lateralizasyon farklılıklarını tespit etmek üzere analiz edilmektedir. Hastaların demografik ve klinik bilgileri, ameliyata ilişkin verileri, yatış süresi, ameliyat sırası ve sonrasındaki komplikasyonları ile patoloji sonuçları analiz edilmiştir. Bulgular: Çalışmaya 96’sı kadın %76 , 31’i erkek %24 127 hasta alındı. Yaş ortalamaları 53’tü SS:±13 . Preoperatif tanı 51 hastada %40,2 Cushing sendromu, 45 hastada %35,4 hormonal aktivite izlenmeyen non-spesifik kitle, 15 hastada %11,8 Conn sendromu, 7 hastada %5,5 benign ve 5 hastada %3,9 malignite şüpheli feokromasitoma, 2 hastada %1,6 metastaz, 1 hastada %0,8 kortikal karsinom, 1 hastada ise %0,8 teratomdu. Biri bilateral 82 hastada %64,6 radyolojik olarak adenom, 16 hastada %12,6 non-spesifik kitle, 8 hastada %6,3 feokromasitoma dışı malignite şüpheli kitle, 7 hastada %5,5 nodül, 5 hastada %3,9 kistik kitle ve 3 hastada %2,4 malignite şüpheli feokromasitoma saptandı. Ortanca tümör çapı 32 mm idi Çeyrekler arası aralık ÇAA : 21-42 . Sonuç: Lateral yaklaşımla hastaya lateral dekübit pozisyon verilerek uygulanan laparoskopik adrenalektomilerde sol taraf girişimlerde daha sık komplikasyon gelişmektedir. Çoğunlukla geniş disseksiyona bağlı kanamalara sekonder gelişen bu komplikasyonlar bu taraf lezyonlarda farklı cerrahi teknik veya ilave tedbirler alınması ihtiyacını vurgulamaktadır

Anahtar Kelimeler

• Adrenalektomi, Laparoskopik cerrahi, Laparoskopik adrenalektomi

Lateralization Differences in Elective Laparoscopic Adrenalectomies

Abstract

Objective: Reportedly, laparoscopy is an effective and safe minimally invasive method for adrenal tumors. The aim of this study was to demonstrate the right-left lateralization differences in the clinical features of laparoscopic adrenalectomy.Material and Methods: Adult patients who underwent transperitoneal laparoscopic unilateral adrenalectomy in the general surgery department of our university, between January 2014 and December 2018, were analyzed in order to determine the differences in lateralization. Demographic and clinical information, surgical data, length of stay, complications during and after surgery, and pathology results were analyzed.Results: A total of 127 patients, 96 female 76% and 31 male 24% , were included in the study. The mean age was 53 SD:±13 years. The preoperative diagnosis was Cushing's syndrome in 51 patients 40.2% , non-specific mass without hormonal activity in 45 patients 35.4% , Conn syndrome in 15 patients 11.8% , benign pheochromocytoma in 7 patients 5.5% , pheochromocytoma with malignancy suspicion in 5 patients 3.9% , metastasis in 2 patients 1.6% , cortical carcinoma in 1 patient 0.8% and teratoma in 1 patient 0.8% . Radiological diagnosis was radiological adenoma in 82 patients 64.6% , non-specific mass in 16 patients 12.6% , non-pheochromocytoma malignancy in 8 patients 6.3% , nodules in 7 5.5% patients, cystic mass in 5 patients 3.9% and pheochromocytoma with malignancy suspicion in 3 patients 2.4% . The median tumor diameter was 32 mm .Conclusion: Patients had more frequent complications in the lateral-approach left laparoscopic adrenalectomies. These complications, which were mostly secondary to bleeding after extensive dissection, emphasize the need for a different surgical technique or additional measures

Keywords

• Adrenalectomy, Laparoscopic surgery, Laparoscopic adrenalectomy

Kaynakça

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