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首页> 外文期刊>Surgical Endoscopy >Previously unreported high-grade complications of adrenalectomy.
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Previously unreported high-grade complications of adrenalectomy.

机译：先前未报告的肾上腺切除术的高级别并发症。

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BACKGROUND: Serious complications of adrenalectomy are rare but the incidence may be underestimated if they occur outside major referral centers. We report five cases of high-grade complications after adrenalectomy that have not been previously described. METHODS: The records of five cases of adrenalectomy performed at outside hospitals were reviewed. Four cases were referred for management of complications and one for medical-legal review. The nature of the adrenal lesion, operative approach, complication(s), and subsequent clinical course and complication management were assessed. Both open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) cases were included. RESULTS: Operative indications were pheochromocytoma (N = 3), aldosteronoma (N = 1), and a nonfunctioning 6-cm hypervascular mass (N = 1). Complications of adrenalectomy included: case 1--complete transection of the porta hepatitis during right LA resulting in hepatic failure requiring emergent liver transplantation; case 2--ligation of the hepatic artery during right OA resulting in recurrent cholangitis and bile duct sclerosis requiring liver transplantation; case 3--ligation of the left ureter during LA resulting in postoperative hydronephrosis and loss of renal function; case 4--loss of left kidney function after OA, likely secondary to renal artery ligation ultimately requiring laparoscopic nephrectomy; case 5--LA of a normal adrenal gland for a 6-cm hypervascular mass thought to be arising from the adrenal gland. Three-month postoperative imaging demonstrated a persistent mass and the patient underwent hand-assisted laparoscopic nephrectomy for a left upper pole renal cell carcinoma that was missed at the time of LA. CONCLUSION: Despite the generally low morbidity of adrenalectomy, serious and potentially life-threatening complications can occur. Surgeon inexperience may be a factor in the occurrence of some of these complications which have not been previously described.
机译：背景：肾上腺切除术的严重并发症很少见，但如果发生在主要的转诊中心以外，则发生率可能会被低估。我们报告了先前未描述的五例肾上腺切除术后严重并发症。方法：回顾了5例在医院外进行的肾上腺切除术的记录。 4例因并发症处理而转诊，1例因医学法律审查而转诊。评估肾上腺病变的性质，手术方式，并发症以及随后的临床过程和并发症管理。包括开放性肾上腺切除术（OA）和腹腔镜肾上腺切除术（LA）病例。结果：手术适应症为嗜铬细胞瘤（N = 3），醛固酮瘤（N = 1）和无功能的6厘米高血管肿块（N = 1）。肾上腺切除术的并发症包括：病例1 –右LA期间门肝炎完全横断，导致肝衰竭，需要紧急肝移植;病例2-在右OA期间结扎肝动脉，导致复发性胆管炎和胆管硬化，需要进行肝移植;病例3-LA结扎左输尿管导致术后肾积水和肾功能丧失;病例4：OA后左肾功能丧失，可能继发于肾动脉结扎，最终需要腹腔镜肾切除术;病例5--正常肾上腺的6厘米高血管肿块被认为是由肾上腺引起的。术后三个月的影像学检查显示持续的肿物，并且患者接受了左上极肾细胞癌的手助腹腔镜肾切除术，这在洛杉矶时被遗漏了。结论：尽管肾上腺切除术的发病率通常较低，但仍可能发生严重且可能危及生命的并发症。外科医生经验不足可能是这些并发症中某些尚未发生的因素。

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