Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2007 / Cilt: 33 - Sayı: 1
Böbrek üstü bezi kitlelerinin değerlendirilmesi
- Sayfa
- 18–23
- DOI
- —
Özet
Bu çalışmada, böbrek üstü bezinde kitle ve Cushing Sendromu nedeniyle açık sürrenalektomi yapılan hastalarımızın özelliklerini gözden geçirmeyi amaçladık. Kliniğimizde Nisan 2004 ile Eylül 2006 tarihleri arasında 16 hastaya (9 kadın, 7 erkek) açık sürrenalektomi yapıldı. Hastaların ortalama yaşı 44,3 yıl idi. Ortalama ameliyat süresi ve hastanede yatış süresi sırasıyla 135 dakika ve 3 gün idi. Bir hastaya adrenal karsinom ön tanısı ile transperitoneal, 15 hastaya flank insizyon ile 11. kot çıkarılarak retroperitoneal sürrenalektomi yapıldı. Ameliyat sonrasında hiçbir hastamızda kanama, komşu organ ve damar yaralanması, pnömotoraks, uzamış drenaj gibi ciddi bir istenmeyen yan etki saptanmadı. Histopatolojik inceleme sonunda, 11 hastada adenom, 2 hastada feokromositoma, 1 hastada miyelipoma, 1 hastada gangliyonöroma, 1 hastada adrenal karsinoma saptandı. Cerrahi sonrası dönemde hiçbir hastada cerrahi istenmeyen yan etki gözlenmedi. Ameliyat öncesinde, feokromositoma ve adrenal karsinoma saptanan hastaların kan ve serum biyokimyasal ölçütleri yüksekti. Cushing Sendromu nedeniyle iki taraflı sürrenalektomi yapılan 2 hastada klinik belirtiler dramatik olarak geriledi. Böbrek üstü bezi kitlelerinin değerlendirilmesinde kitle boyutu, hastanın belirtileri ve kitlenin fonksiyonel olması göz önünde bulundurulması gereken kritik noktalardır. Flank insizyon ile 11. kot çıkarılarak yapılan retroperitoneal sürrenalektomi güvenli, düşük istenmeyen yan etki oranına sahip ve kolay uygulanabilir bir yöntem gibi görünmektedir.
Abstract
Introduction: The increased use of abdominal ultrasound and abdominal tomography scanning has led to the frequent finding of an unexpected adrenal mass, or an incidentaloma. Unexpected adrenal masses have been detected on 1.4% to 8.7% of upper abdominal imaging studies. Adrenal masses usually small than 2 cm in 80%, benign (94%), and non-functioning (90%). Adrenal carcinoma is a rare disease and has a poor prognosis. A practical sub-classification for adrenal carcinoma is according to their ability to produce adrenal hormones. Most of adrenal carcinomas (79%) are functional and non-functional carcinomas may become functional in the future. Adrenal malignancies are usually larger than 5 cm and exploration must be performed when the mass is bigger than 5 cm on computerized tomography and magnetic resonance imaging. In this study, we assessed the features of our patients who underwent open surrenalectomy due to surrenal mass and Cushing Syndrome. Materials and Methods: Between April 2004 and September 2006, 16 patients (9 women, 7 men) underwent open surrenalectomy (One transperitoneal via Chevron incision, 15 retroperitoneal via flank incision with 11th rib resection) in our clinic. Right and left surrenalectomy were done in 6 and 8 patients, respectively. Also, 2 patients underwent bilateral surrenalectomy. The patients were evaluated with medical history, physical examination, computerized tomography, magnetic resonance imaging, serum biochemistry, serum cortisol, serum aldosterone, serum dehydroepiandrosterone sulfate levels, urinary cortisol, urinary vanil mandelic acid and urinary metanefrin levels. Results: The mean age of the patients was 44.3±13.8 (range: 17-65) years. The mean mass size was 3.5±3.4 (range: 1-14) cm. In men and women, the mean age was 44.1 and 42.4 years, respectively (p=0.963). We did not find significant difference in terms of mean size of mass between men and women (3.2 vs 4.5 cm) (p=0.206). The mean operation and hospitalization times were 135 minutes and 3 days, respectively. Transperitoneal surrenalectomy was performed in 1 patient, retroperitoneal surrenalectomy via flank incision with 11th rib resection. Histopathological examination revealed adenoma in 11 patients, feochromositoma in 2 patients, myelipoma in 1 patient, ganglioneuroma in 1 patient, adrenal carcinoma in 1 patient were diagnosed. Preoperative serum and urinary biochemistry parameters were higher than normal ranges in the patients with feochromositoma, adrenal carcinoma and Cushing syndrome. Clinical symptoms dramatically regressed after surgery in the patients who had Cushing syndrome. No surgical complication was observed during postoperative course. Conclusion: The adrenal masses should be evaluated by the combination of clinical, biochemical and radiological methods. The mass size, patient’s symptoms and functional mass are critical points in the evaluation of surrenal masses. The retroperitoneal surrenalectomy via flank incision with 11th rib resection seems to be a safe and easy approach with low morbidity rates.