Characteristics of central adrenal vein anatomy and variability in retroperitoneal laparoscopic right adrenalectomy

doi:10.3877/cma.j.issn.1674-3253.2021.03.009

Abstract

Abstract:

Objective

To analyze and summarize right central adrenal vein (CAV) anatomy characteristics and variability, and investigate the safe and efficient method to process CAVs in retroperitoneal laparoscopic right adrenalectomy (RLRA).

Methods

The clinical data of 61 patients who underwent RLRA performed by the same surgeon from September 2016 to March 2019 were retrospectively analyzed. During operation, the "three-plane" technique was applied to dissect adrenal gland, the inferior vena cava (IVC) was used as an anatomical landmark to carefully search for and expose right CAV, then CAV was clipped with Hem-o-loks and transected under direct vision.

Results

All 61 operations were performed successfully with two conversion to open surgery due to adhesion. Among them, 57 patients had normal CAV anatomy, while 4 patients had CAV variants (6.56%): one CAV draining into hepatic vein (n=1), two CAVs draining into IVC (n=2), two CAVs draining separately into IVC and hepatic vein (n=1). Peritoneum perforation occurred in one case during operation (1.64%) without conversion to open surgery. Postoperative fever (>38.5℃) occurred in 2 patients (3.28%), no other complication occurred. The mean operative time was (83±27) minutes. The average postoperative hospital stay was (3.52±0.77) days. Postoperative pathological examination revealed: cortical adenoma in 53 cases (86.89%), adrenal cyst in 4 cases (6.56%), pheochromocytoma in 3 cases (4.92%), and lymphangioma in 1 case (1.64%).

Conclusions

Being familiar with CAV anatomy and variability is of utmost importance to accurately locate CAV during RLRA, which can effectively reduce surgery risk, and guarantee the safety of surgery.

Key words: Retroperitoneal laparoscopy, Adrenal gland, central adrenal vein, Anatomy, Variability

Fangming Wang, Guiming Zhang, Yong Liu, Lijiang Sun. Characteristics of central adrenal vein anatomy and variability in retroperitoneal laparoscopic right adrenalectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(03): 221-225.

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References 19

[1]	Janetschek G, Neumann HP. Laparoscopic surgery for pheochromocytoma[J]. Urol Clin North Am, 2001, 28 (1): 97-105.
[2]	Barczyński M, Konturek A, Nowak, W. Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up[J]. Ann Surg, 2014, 260(5): 740-777.
[3]	Constantinides VA, Christakis I, Touska P, et al. Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience[J]. Surg Endosc, 2013, 27(11): 4147-52.
[4]	张旭. 解剖性后腹腔镜肾上腺切除术的手术方法和技巧[J]. 临床泌尿外科杂志, 2007, 22(8): 561-564
[5]	Parnaby CN, Galbraith N, O'Dwyer PJ. Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy[J]. Clin Anat, 2008, 21(7): 660-665.
[6]	Scholten A, Cisco RM, Vriens MR, et al. Variant adrenal venous anatomy in 546 laparoscopic adrenalectomies[J]. JAMA Surg，2013，148(4): 378-383.
[7]	Zhang X, Fu B, Lang B, et al. Technique of anatomical retroperitoneoscopic adrenalectomy with report of 800 cases[J]. J Urol, 2007, 177(4): 1254-1257.
[8]	Vassiliou MC, Laycock WS. Laparoscopic adrenalectomy for pheochromocytoma: take the vein last? [J]. Surg Endosc, 2009, 23(5): 965-968.
[9]	王琦，于德新，王毅, 等. 膈下静脉在后腹腔镜单层面下左侧肾上腺切除术中的应用价值[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(2): 90-93.
[10]	Sebe PMPeyromaure A,Raynaud V,et al. Anatomical variations in the drainage of the principal adrenal vein:the results of 88 venograms[J].Surg Radiol Anat, 2002, 24(3): 222-225.
[11]	高江平，王威，郭刚, 等. 腹腔镜肾上腺手术肾上腺中央静脉的应用解剖[J]. 中国内镜杂志, 2005, 11(6): 632-633, 636.
[12]	Johnstone FR. The suprarenal veins[J]. Am J Surg, 1957, 94(4): 615-620.
[13]	Clark K. The blood vessels of the adrenal gland[J]. J R Coll Surg Edinb, 1959, 4(3): 257-262.
[14]	Davidson JK, Morley P, Hurley GD,et al. Adrenal venography and ultrasound in the investigation of the adrenal gland: an analysis of 58 cases[J]. Br J Radiol, 1975, 48(570): 435-450.
[15]	Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava[J]. Surg Gynecol Obstet,1981, 152(1): 43-50.
[16]	El-Sherief MA. Adrenal vein catheterization: anatomic considerations[J]. Acta Radiol Diagn (Stockh). 1982, 23(4): 345-360.
[17]	Monkhouse WS, Khalique A. The adrenal and renal veins of man and their connections with azygos and lumbar veins[J]. J Anat, 1986, 146(29): 105-115.
[18]	占志兵. 后腹腔镜下处理肾上腺变异和病变血管有效方法的研究[D]. 广州医科大学, 2017.
[19]	Zielke A, Middeke M, Hoffmann S, et al. VEGF-mediated angiogenesis of human pheochromocytomas is associated to malignancy and inhibited by anti-VEGF antibodies in experimental tumors[J]. Surgery, 2002, 132(6): 1056-1063.

指标		数据
性别[例(%)]
	男性	29（47.54）
	女性	32（52.46）
年龄[岁，(±s)]		55±10
体质量指数[kg/m²，(±s)]		27±5
诊断[例(%)]
	无功能腺瘤	45（73.77）
	原发性醛固酮增多症	9（14.75）
	嗜铬细胞瘤	3（4.92）
	囊肿	4（6.56）
肿瘤最大径[cm，(±s)]		2.6±1.2
手术时间[min，(±s)]		83±27
术中出血量[ml，(±s)]		20（10～200）
术后引流天数[d，(±s)]		2.3±0.5
术后住院天数[d，(±s)]		3.5±0.8
并发症[例(%)]
	腹膜破损	1（1.64）
	术后发热	2（3.28）
中转开放[例(%)]		2（3.28）
输血例数[例(%)]		0（0）

指标		数据
性别[例(%)]
	男性	29（47.54）
	女性	32（52.46）
年龄[岁，(±s)]		55±10
体质量指数[kg/m²，(±s)]		27±5
诊断[例(%)]
	无功能腺瘤	45（73.77）
	原发性醛固酮增多症	9（14.75）
	嗜铬细胞瘤	3（4.92）
	囊肿	4（6.56）
肿瘤最大径[cm，(±s)]		2.6±1.2
手术时间[min，(±s)]		83±27
术中出血量[ml，(±s)]		20（10～200）
术后引流天数[d，(±s)]		2.3±0.5
术后住院天数[d，(±s)]		3.5±0.8
并发症[例(%)]
	腹膜破损	1（1.64）
	术后发热	2（3.28）
中转开放[例(%)]		2（3.28）
输血例数[例(%)]		0（0）

	例数	性别(例)		年龄[岁，(±s)]	体质量指数[例(%)]		肿瘤最大径[cm，(±s)]
	例数	男	女	年龄[岁，(±s)]	< 25 kg/m²	≥25 kg/m²	肿瘤最大径[cm，(±s)]
嗜铬细胞瘤	3	1	2	54±14	2(66.67)	1(33.33)	4.93±0.95
原醛症	9	5	4	56±12	5(55.56)	4(44.44)	1.69±0.45
无功能腺瘤	45	22	23	56±8	16(35.56)	29(64.44)	2.50±0.82
囊肿	4	1	3	49±18	1(25)	3(75)	3.80±2.47
非嗜铬细胞瘤	58	28	30	55±10	22(37.93)	36(62.07)	2.47±1.05
P1值		0.789		0.643	0.537		<0.001
P²值		0.537		0.757	0.556		<0.001
	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流天数[d，(±s)]	术后住院天数[d，(±s)]	中央静脉类型[例(%)]
	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流天数[d，(±s)]	术后住院天数[d，(±s)]	正常型	变异型
嗜铬细胞瘤	85±25	30(30～30)	3.00±1.00	4.33±1.53	1(33.33)	2(66.67)
原醛症	83±15	.20(20～30)	2.22±0.14	3.11±0.60	8(88.89)	1(11.11)
无功能腺瘤	83±30	20(20～25)	2.24±0.43	3.58±0.72	44(97.78)	1(2.22)
囊肿	79±17	20(20～27)	2.25±0.50	3.25±0.50	4(100)	(0)
非嗜铬细胞瘤	83±27	20(20～30)	2.24±0.43	3.48±0.71	-	-
P1值	0.989	0.213	0.078	0.070	0.005
P²值	0.906	0.095	0.437	0.319	0.010

	例数	性别(例)		年龄[岁，(±s)]	体质量指数[例(%)]		肿瘤最大径[cm，(±s)]
	例数	男	女	年龄[岁，(±s)]	< 25 kg/m²	≥25 kg/m²	肿瘤最大径[cm，(±s)]
嗜铬细胞瘤	3	1	2	54±14	2(66.67)	1(33.33)	4.93±0.95
原醛症	9	5	4	56±12	5(55.56)	4(44.44)	1.69±0.45
无功能腺瘤	45	22	23	56±8	16(35.56)	29(64.44)	2.50±0.82
囊肿	4	1	3	49±18	1(25)	3(75)	3.80±2.47
非嗜铬细胞瘤	58	28	30	55±10	22(37.93)	36(62.07)	2.47±1.05
P1值		0.789		0.643	0.537		<0.001
P²值		0.537		0.757	0.556		<0.001
	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流天数[d，(±s)]	术后住院天数[d，(±s)]	中央静脉类型[例(%)]
	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流天数[d，(±s)]	术后住院天数[d，(±s)]	正常型	变异型
嗜铬细胞瘤	85±25	30(30～30)	3.00±1.00	4.33±1.53	1(33.33)	2(66.67)
原醛症	83±15	.20(20～30)	2.22±0.14	3.11±0.60	8(88.89)	1(11.11)
无功能腺瘤	83±30	20(20～25)	2.24±0.43	3.58±0.72	44(97.78)	1(2.22)
囊肿	79±17	20(20～27)	2.25±0.50	3.25±0.50	4(100)	(0)
非嗜铬细胞瘤	83±27	20(20～30)	2.24±0.43	3.48±0.71	-	-
P1值	0.989	0.213	0.078	0.070	0.005
P²值	0.906	0.095	0.437	0.319	0.010

文献来源	年份	例数	变异例数（%）
Johnstone^[12]	1957^*	10	5（50）
Clark^[13]	1959^*	16	10（62.5）
Davidson等^[14]	1975^*	50	2（4）
Nakamura等^[15]	1981^*	83	11（13.3）
El-Sherief^[16]	1982^*	20	11（55）
Monkhouse等^[17]	1986^*	45	18（40）
Parnaby等^[5]	2008^*	79	2（2.5）
Scholten等^[6]	2013^*	250	42（16.8）
占志兵^[18]	2017^*	38	6（15.8）
我们的研究	2019^*	61	4（6.56）

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