Year 2015 Vol. 23 No 2

GENERAL AND SPECIAL SURGERY

.N. SADRIEV 1, .D. GAIBOV 1,2

JUSTIFICATION OF SURGICAL APPROACH CHOICE TO ADRENALECTOMY

Avicenna Tajik State Medical University 1,
Republican Scientific Center of Cardiovascular Surgery 2,
Dushanbe
The Republic of Tajikistan

Objectives. To justify the choice of surgical approaches to adrenalectomy based on the data of instrumental findings.
Methods. Comparative results of adrenalectomies through different surgical approaches in 51 patients with adrenal tumors have been analyzed. To choose an optimal surgical approach to adrenalectomy its necessary to take into consideration the depth of the adrenal tumor location, the angle of surgical action, the size of adrenal tumor, its location, presence of an accompanying pathology requiring surgical treatment. The parameters mentioned above were determined by means of ultrasonography (US), computer tomography and multislice computed tomography (MSCT). All data obtained from this run compared with the intraoperative findings.
Results. The depth of adrenal location was measured by means of US, CT, MSCT from various surgical approaches made up from 5,70,5 up to 12,90,6 and from 5,60,7 up to 12,80,9 cm (̱σ), respectively. The surgical action angle determined by means of CT and MSCT varied from 36 up to 142 in all cases coinciding with intraoperative findings. The length of mini-lumbotomic approach (n=19) was from 4,8 up to 6,5 cm, (the average 5,40,2 cm (̱σ). Only 5,9% of cases there are data inconsistency in comparison the results of US, CT and MSCT with intraoperative one. Adrenalectomy from thoraco-phrenico- lumbotomic (TPL) approach was performed in 30 (58,8%) patients, from mini-lumbotomic (ML) approach in 21 (41,2%) patients. Conversion frequency of ML approach made up 9,5%. Intraoperative complications at TPL approach were registered in 6,7% cases, at ML approach in 4,8%.
Conclusion. Application of US, CT and MSCT permitted to determine maximally accurately the size and location of the adrenal tumor, to establish the tumor location, required different surgical approaches as well as the expected angle of surgical action thus to contribute to the optimal choice of surgical approach.

Keywords: adrenal tumors, adrenalectomy, surgical treatment, thoraco-phrenico-lumbotomy, mini-lumbotomy, approach, complications
p. 145-153 of the original issue
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Address for correspondence:
734003, Respublika Tadzhikistan,
g. Dushanbe, prospekt Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy
meditsinskiy universitet imeni Abuali ibni Sino,
kafedra khirurgicheskih bolezney 2.
tel.: 992 915 25 00 55;
e-mail: sadriev_o_n@mail.ru,
Sadriev Okildzhon Nemadzhonovich
Information about the authors:
Sadriev O.N. A post-graduate student of the surgical diseases chair 2 of Avicenna Tajik State Medical University.
Gaibov A.D. Corresponding member of Medical Sciences academy of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, MD, professor of the surgical diseases chair 2 of Avicenna Tajik State Medical University, professor and tutor of the vascular surgery department of the Republican Scientific Center of Cardiovascular Surgery.
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