Adrenal gland tumor
1.Adrenal gland tumor
Adrenal gland is that, working secretes various kinds of hormones necessary to maintain life with small organ which there is on the bilateral kidney one by one. Tumor occurring from adrenal gland has thing producing hormone excessively and presents symptom characteristic each depending on the hormone (we showed below representative hormone-producing adrenal gland tumor). In addition, there is the frequency for malignant tumor with less than 10% although it is low. Adrenal gland tumor becoming adaptation of operation cannot deny hormone-producing adrenal gland tumor and malignant tumor or malignancy, but higher than tumor diameter 3cm recommend operation even to adrenal gland tumor which does not produce hormone positively because it is difficult to diagnose malignant tumor by video diagnosis exactly. Adaptation of laparoscopic surgery assumes benign tumors less than tumor diameter 5cm in hormone-producing adrenal gland tumor and non-hormone-producing adrenal gland tumor for these tumors.
2.Representative hormone-producing adrenal gland tumor
Increase, muscle weakness of urine flow associated with high blood pressure and low K blood disease due to excess secretion of aldosterone are main symptoms. The percent improvement of high blood pressure is 70-80%.
We take various clinical manifestations such as central obesity, moonface, skin filamentous, hypertrichosis, amenorrhea, muscle weakness, high blood pressure, hyperglycemia, osteoporosis by excess secretion of cortisol. Postoperative hormone replacement is necessary.
③Pre-clinical Cushing's syndrome
It may present high blood pressure, hyperglycemia due to excess secretion of cortisol, but does not detect symptom that is characteristic of Cushing's syndrome. Hormone replacement may be necessary after the operation.
We take various clinical manifestations such as high blood pressure, heartbeat, sweat, headache, hyperglycemia, hyperlipidemia by excess secretion of catecholamine (adrenalin, noradrenaline). It is asymptomatic and may be discovered accidentally. Is familial, and is bilateral, vice-; is extrarenal, and approximately 10% of malignancies exist.
We pour carbon dioxide into in abdomen and blow up and are operation method to do adrenal gland in group with tumor by outside the body operation using camera and slim surgical instrument from 3-4 places of holes which we opened to skin, and to extract. We experience more than 150 adrenal gland tumor operation cases (50 cases of them laparoscopic surgery) in this hospital and decide open surgery and adaptation of laparoscopic surgery to condition of patient. Operation uses epidural anaesthesia together with general anesthesia and performs and it is finished in many cases in approximately four hours, but we may need long time for the adhesion around the adrenal gland and may shift to open surgery in some cases.
4.General course of laparoscopic adrenalectomy
It is different, but follows the following course by individual patients after surgery generally.
5.Complications that are possible by laparoscopic adrenalectomy
Operation invasion is accompanied, and most are improved by intravenous feeding treatment.
・Post-operative haemorrhage, the damage of adrenal neighborhood organ
Most are improved by rest, but may perform hemostasis and repair by reoperation.
・Deep vein thrombosis, pulmonary thrombosis
Clot (gore) is formed on deep part vein of lower limbs, and it comes off, and blood vessel of the lungs may be clogged up to bloodstream.
As the prevention, we wear elastic stockings from all over the operation.
・We separate wound infection, wound
Wound dehiscence may happen by infection of wound. It is easy to occur toward diabetes, the obesity,
We may need washing of wound and re-suture.
・Postoperative ileus (ileus)
Movement of the bowels may worsen under the influence of operation or anesthesia temporarily. In that case, it is necessary to put thin pipe in stomach and the bowels from nose.
6.Length of stay and expense of operation
It is patients individual than surgical method, condition, progress after surgery and is different, but usually needs hospital care for 5-14 days. Health insurance is applied about expense accompanied with hospitalization, operation, and burden on person of 30% burden is approximately 250,000 yen.